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Patients referring themselves to accident and emergency departments in two districts were compared: West Somerset, a sparsely populated semi-rural district with 113 general practitioners, and Islington, a densely populated, deprived urban district with 86 general practitioners. It was found that an Islington resident is twice as likely to attend the accident and emergency department. A slightly higher proportion of Islington attenders came with a general practitioner's referral letter and there were many more unregistered attenders, which probably reflected a much more mobile population. Interesting comparisons were found between the registered and unregistered attenders in Islington. Islington attenders were two and a half times more likely to come with a non-emergency. The West Somerset attender was nearly twice as likely to arrive with a genuine accident.