Following the accession of Poland to the European Union in 2004, large numbers of Polish migrant workers have come to the UK. We describe how this migration has impacted on an emergency department in the West Midlands, and suggest advice that should be given to such visitors about how to use the NHS.O n 1 May 2004 10 new countries, including the Republic of Poland, joined the European Union (EU). This allowed the free movement to the UK of workers from these countries. Soon after this date it was noticed that increasing numbers of patients of Polish origin were attending the emergency department at the Princess Royal Hospital, Telford. It was further noted that many of these attendances related to general practice conditions, and that these episodes were often complicated by language difficulties. We performed a retrospective study in order to analyse this phenomenon. METHODSPatients of Polish origin who had attended the emergency department at the Princess Royal Hospital, Telford, were identified using a novel computer program that assigns a country of origin according to a patient's given and family names.1 Using this software the emergency department's records of the past 6 years were screened, up to and including 2005. Patients of Polish origin were further subdivided into those who were registered with a general practitioner (GP) and those who were not.Of the unregistered Polish patients who attended in 2005, a convenience sample of 90 were further analysed. In particular, the appropriateness of the attendance was assessed by experienced practitioners in emergency medicine and in general practice, using agreed criteria (see appendix) and the notes were reviewed for any comments relating to communication difficulties. RESULTSThe results show that in the first 18 months following the expansion of the EU there was a significant increase in patients of Polish origin attending the emergency department at the Princess Royal Hospital, Telford (fig 1). Such attendances rose by over 150% from an average of 134 (2000)(2001)(2002)(2003) to 357 in 2005. Of these 357 patients, 152 (43%) were not registered with a GP. The departmental average for unregistered patients was 7.4%.Analysis of a convenience sample of 90 of the unregistered Polish patients who attended in 2005 showed that there were communication difficulties in at least 47 cases (52%) and that 35 (39%) presented with conditions that could have been treated by a GP. DISCUSSIONThese statistics show a significant increase in the number of attendances of patients of Polish origin to the emergency department at the Princess Royal Hospital, Telford, since Poland acceded to the EU in May 2004. The data further indicate that many of these attendances were complicated by communication difficulties, and could have been dealt with by a GP.Emergency departments have a duty to provide a timely and accurate service to all patients, regardless of their ability to speak English. Communication difficulties, however, can jeopardise good care and can be associated with consider...

or anyone still uncertain about the concept, See and Treat is a process whereby patients with minor conditions are seen soon after they arrive in A&E by a senior clinician. Providing they have an appropriate problem such patients are given their definitive treatment straightaway and can then be discharged. The Department of Health is very anxious that all A&E departments should adopt See and Treat and has organised a road show that has toured the UK spreading the word. Circulars and emails, arriving on an almost daily basis, have encouraged senior A&E staff to attend these meetings. One recent DoH letter even asked departments when, not whether, they would be introducing See and Treat. The star turn at the See and Treat road show is the Kettering A&E Department. Kettering had its Eureka moment when it found that it's throughput times were rising because all its cubicles (both major and minor) were blocked by patients waiting for admission. With the encouragement of its chief executive the A&E departments response was to employ its most senior doctors and nurses in offices close to the waiting room where they found they could See and Treat quite a lot of patients with minor problems. This improved their department's deteriorating throughput times. Many people might think that the proper response of the chief executive in this situation should have been to ask why his A&E department was being blocked by patients waiting for a bed. Furthermore, how representative is the A&E department in Kettering and are its solutions appropriate for more successful A&E departments? Is it appropriate for the most experienced A&E staff to see the patients with the least serious conditions?

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