Drivers of Demand for Emergency and Urgent CarE services (DEUCE): understanding patients' and public perspectives


In England, urgent care is provided by a range of services including emergency services (999 ambulance service, emergency departments and hospitals dealing with emergency admissions), urgent care services (GP out of hours, minor injury units, walk-in centres, NHS 111) and in-hours general practice (requests for same day appointments and telephone advice).

Emergency department sign outside hospitalConcerns have been expressed about the increase in demand for some of these services (specifically ambulance, emergency department and in-hours general practice) and their capacity to deal with this demand. A key concern is the use of a higher acuity service than is clinically necessary. For example, people attending an emergency department when their problem could be dealt with by general practice, or people using urgent appointments with GPs when scheduled appointments or self-care could be used.

We need to know more about population attitudes to seeking health care, reasons for people’s decision-making, and what might help people to make choices.

The intention is that it will help policy makers to plan future ways of managing demand so that service provision works for patients and is sustainable in the future.

We plan to undertake three sequential studies.Close-up of ambulance

Work Package 1..... is a realist synthesis of how people make decisions to use different types of services for urgent care. We will build on recent reviews which identify the range of factors affecting demand for emergency and urgent care services by identifying underlying reasons for the decisions people make, potential ways of reducing clinically unnecessary use of services, and gaps in the evidence base in terms of important sub-groups which have not been studied sufficiently.

Boy with thermometerWork Package 2..... is a qualitative study, interviewing people about how they make decisions to use emergency services, urgent care services, routine or self-care. We will interview three sub-groups of the population who have been identified as making clinically unnecessary use of services but where little qualitative research has been undertaken. Interviews will focus on why people make decisions to contact different services, trying to understand what lies at the heart of their behaviour and what might help them to use non-urgent services or self-care when it is not clinically necessary to use emergency or urgent services. Three focus groups will identify potential solutions to help people in their decision-making.

Doctor with patientWork Package 3..... is a national survey of 3000 adults in Britain, undertaken as part of the NatCen British Social Attitudes survey. We will add a number of questions to this survey. Questions will be informed by a recent rapid review (Turner 2015), the findings from WPs 1 and 2, a PPI event, and the HS&DR-funded Turnbull study of sense-making strategies and help-seeking behaviours. We will ask about attitudes towards seeking help from different providers of emergency and urgent care, including perceptions of availability of services, expectations of a 24/7 culture, preferences for emergency care services, risk perception, awareness of alternative services and health literacy. We will measure the proportions of people who have different attitudes and which of these affects the propensity to use levels of services that are not clinically necessary. We will look at how these attitudes vary by different population sub-groups.

Our research team

Professor Alicia O’Cathain (Lead investigator/WP1 lead)
Dr Emma Knowles (Project manager/WP2 lead)
Joanne Coster 
Janice Connell
Lindsey Bishop-Edwards
Dr Jaqui Long
Dr Richard Jacques
Janette Turner
Professor Steve Goodacre
Dr Liz Croot
Dr Jon Dickson
Enid Hirst (PPI representative)
Shan Bennett (PPI representative)
Linda AbouZeid (PPI representative)

Miranda Phillips (National Centre for Social Research & WP3 lead)
Joanne Turnbull (University of Southampton)


NIHR (Health Services and Delivery Research Programme). Study start date 1st February 2017

For further details about this research, please contact Sue Ridgway, clerical officer at