Patients using casualty instead of out-of-hours GP care are adding to pressures at Oxfordshire's hospitals.

Accident and emergency staff at the John Radcliffe Hospital in Oxford, and the Horton, Banbury, are dealing with a 12 per cent increase in admissions. They say many of their patients could easily be treated in a community setting.

Instead of using new out-of-hours services or waiting to see their own doctors, they are visiting hospitals for quick care -- jeopardising doctors and nurses' attempts to treat 98 per cent of their patients within four hours.

The Oxford Radcliffe Hospitals NHS Trust, which oversees the JR and Horton, is now urging primary care trusts, responsible for GP care, to help ease the situation.

Dr John Reynolds, clinical chairman of ORH division A, said: "It would be unfair to say GP out-of-hours services are a failure. It's more a change in behaviour in the general public. If you can be seen in four hours at A&E, why wait 48 hours to see your GP? If you can't guarantee to see your own GP out-of-hours, why not go to casualty instead?

"The way we deal with that is difficult. It's about changing mass behaviour. One of the ideas is having a GP at the JR site, like at the Horton."

Although casualty staff are meeting the Government-set four-hour deadline, ORH lead director for emergency care Ailsa Granne said it was becoming harder to achieve as more people used the department.

She said: "Every month we're seeing more attendances in admissions than we did in the same month the previous year, with a 12 per cent increase across the two sites. If we have a lot of people in the department all the time we have to focus very hard on the 98 per cent target.

"Many of these patients could be seen in primary care. There are plans for a different model of primary care, but this is all taking time. It's a pressure."

Mrs Granne said staff were also struggling to meet the target because of delays in transferring hospital patients who no longer required critical care, but were too ill to go home and needed to go to a nursing home or community hospital.

She said the trust had worked hard with Oxfordshire County Council to reduce delayed transfers, which last year topped 100 every day.

She said: "If there are only 50 patients waiting as delayed transfers we always reach our 98 per cent target in A&E, but at the moment there's about 70 at any one time, so it's still an issue for us. It's very clear where the changes need to be made. The community hospitals to whom we want to admit have delays themselves." Oxfordshire PCTs said they were working hard to encourage people to use out-of-hours services, set up across the county when GPs opted out of emergency care as part of their new contract in September last year.

A spokesman for Cherwell Vale and North Oxfordshire PCTs said: "We're all working on promoting the out-of-hours service and sign-posting patients to the appropriate services for their needs.

"By July, the whole of Oxfordshire will use a single point telephone line for out-of-hours, which will simplify the system for patients."

An Oxford City PCT spokesman said the city's out-of-hours service was very successful, and about 2,000 people called for help every month. She said: "We're aware of the issue at the ORH and are in discussion with the trust to look at a number of options which could help."

Lorna Brown, head of social care for adults at the county council, said social services was doing all it could to reduce delayed discharges at the county's major hospitals, including buying beds at private care homes, but said not all delays were social services' fault.