Acknowledgements
The co-authors would like to acknowledge the significant contributions made to the project by Nigel Pearson – Project Officer (2017–20) and Charlotte Bonner-Evans (Project Officer 2019). We thank Professor Deborah Fitzsimmons, Swansea University for supporting the health economics elements of the project. We also wish to thank particularly staff and patients at the 13 selected case study sites who participated in interviews and other elements of the study, and participants from other sites who took part in the baseline survey and selected interviews.
We thank staff at NHS Digital and SAIL Databank for assistance with provisioning data (Case number DARS-NIC-267223-D4Q3F, with data sharing agreement; all patient data were anonymised). We thank South Wales Research Ethics Committee for advice, support and approval for the study (IRAS 217765). We thank colleagues at the University of West of England and elsewhere in the parallel NIHR study of GPs in EDs, led by Professor Jonathan Benger, with whom we collaborated for the survey, Taxonomy and in selecting different study sites (and with data-sharing agreement). We also thank all members of the Study Steering Committee and project managers at HSDR for their support and advice throughout the study duration.
Contributions of authors
Freya Davies (https://orcid.org/0000-0002-6956-1100) (Senior Clinical Research Fellow, Primary Care) was the realist methods lead and led final report drafting.
Michelle Edwards (https://orcid.org/0000-0001-7432-2828) (Research Fellow, Qualitative Methods) conducted ethical approvals, qualitative data collection and analysis.
Delyth Price (https://orcid.org/0000-0002-4659-2908) (Research Assistant) conducted qualitative data analysis.
Pippa Anderson (https://orcid.org/0000-0003-2959-2671) (Associate Professor, Health Economics) was the methodological lead for health economics.
Damon Berridge (Late Professor of Statistics) led for time-series analysis design; RIP.
Andrew Carson-Stevens (https://orcid.org/0000-0002-7580-7699) (Clinical Professor of Patient Safety and Quality Improvement) was an academic GP and methodological lead for patient safety incident report analysis.
Mazhar Choudhry (https://orcid.org/0000-0001-8052-3490) (Former Cardiff University Medical Student) conducted qualitative data analysis of finance manager interviews.
Matthew Cooke (https://orcid.org/0000-0002-1038-3821) (Professor of Clinical Systems Design) conducted study design and provided emergency medicine policy and delivery expertise.
Jeremy Dale (https://orcid.org/0000-0001-9256-3553) (Professor of Primary Care) was an academic GP and conducted study design and provided unscheduled care research expertise.
Liam Donaldson (https://orcid.org/0000-0001-9170-6057) (Professor, WHO Patient Safety Envoy) conducted study design and provided National and International Patient Safety Policy context.
Bridie Angela Evans (https://orcid.org/0000-0003-0293-0888) (Research Officer, Public Involvement) was the public involvement lead.
Barbara Harrington (Welsh Government Involving people in research network) was a public contributor.
Shaun Harris (https://orcid.org/0000-0001-7724-6621) (Research Officer, Health Economics) conducted health economics data collection and analysis.
Julie Hepburn (Welsh Government Involving people in research network) was a public contributor.
Peter Hibbert (https://orcid.org/0000-0001-7865-343X) (Honorary Associate Professor, Patient Safety) conducted study design and provided patient safety expertise.
Thomas Hughes (https://orcid.org/0000-0001-5490-1267) (Consultant in Emergency Medicine) provided clinical and Emergency Care Data Set expertise.
Faris Hussain (https://orcid.org/0000-0002-7840-6815) (Former Cardiff University Medical Student) conducted the ambulatory care sensitive condition literature review.
Saiful Islam (https://orcid.org/0000-0003-3182-8487) (Statistician) conducted quantitative data analysis.
Rhys Pockett (https://orcid.org/0000-0003-4135-7383) (Senior Lecturer, Health Economics) conducted health economics data analysis.
Alison Porter (https://orcid.org/0000-0002-3408-7007) (Associate Professor, Health Services Research) provided unscheduled care and qualitative methods expertise.
Tim Rainer (Consultant in Emergency Medicine) provided unscheduled care research expertise.
Aloysius Niroshan Siriwardena (https://orcid.org/0000-0003-2484-8201) (Professor of Primary and Pre-Hospital Health Care) was an academic GP and provided unscheduled and pre-hospital care research expertise.
Helen Snooks (https://orcid.org/0000-0003-0173-8843) (Professor of Health Services Research) conducted study design and provided unscheduled care research expertise.
Alan Watkins (https://orcid.org/0000-0003-3804-1943) (Professor of Statistics) led routine data collection and analysis.
Adrian Edwards (https://orcid.org/0000-0002-6228-4446) (Professor of Primary Care) was the Principal Investigator, an academic GP and provided mixed methods expertise applied to unscheduled care
Alison Cooper (https://orcid.org/0000-0001-8660-6721) (Clinical Research Fellow, Primary Care) conducted study design, was the study management group lead researcher, and conducted qualitative and patient safety data collection and analysis.
Disclosure of interests
Full disclosure of interests: Completed ICMJE forms for all authors, including all related interests, are available in the toolkit on the NIHR journals Library report publication page at https://doi.org/10.3310/JWQZ5348.
Primary conflicts of interest: Liam Donaldson declares his role on the Integrated Care Board for North East and North Cumbria. Bridie Angela Evans is a co-applicant on the following NIHR-funded studies: Randomised trial of clinical and cost effectiveness of Administration of Prehospital fascia Iliaca compartment block for emergency Pre-Hospital hip fracture care Delivery (RAPID 2); Predictive RIsk Stratification Models: Assessment of Implementation Consequences (PRISMATIC 2). Julie Hepburn declares the receipt of honoraria and travel allowances for attending meetings as a public contributor. Thomas Hughes declares his role as NHS Clinical Lead for the implementation of the Emergency Care Data Set; Aloysius Niroshan Siriwardena declares involvement in grants from NIHR for unrelated studies; Alan Watkins declares his role as a member, NIHR HS&DR Funding Committee 2018–22 and as a member, NIHR College of Experts 2020–21; Helen Snooks is a current member of the NIHR HTA and EME Editorial Board, and is an NIHR Journals Library Editor. Alison Cooper reports sustenance costs covered by Cardiff University for qualitative data collection at case site visits. All other authors declare no conflicts of interest.
Patient data statement
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Data-sharing statement
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Ethics statement
Ethical approval for Phase One activities was provided by Cardiff University School of Medicine Research Ethics Committee (REF 17/45). Ethical approval for Phase 2 activities was provided by the South Wales Research Ethics Committee REC reference 17/WA/0328.
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Department of Health and Social Care disclaimer
This publication presents independent research commissioned by the National Institute for Health and Care Research (NIHR). The views and opinions expressed by the interviewees in this publication are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, MRC, NIHR Coordinating Centre, the HSDR programme or the Department of Health and Social Care.
This monograph was published based on current knowledge at the time and date of publication. NIHR is committed to being inclusive and will continually monitor best practice and guidance in relation to terminology and language to ensure that we remain relevant to our stakeholders.
Disclaimers
This manuscript presents independent research funded by the National Institute for Health and Care Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, the HSDR programme or the Department of Health and Social Care. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, the HSDR programme or the Department of Health and Social Care.