BACKGROUND Despite invaluable national data, reasons for the relentless rise in England's emergency department (ED) attendances remain elusive. METHODS All EDs and general practices in England. OBJECTIVE Are rising ED attendances related to general practice patient satisfaction, i.e. if patients are unable to get a convenient appointment with their general practitioner (GP), then do they attend their local ED for diagnosis, treatment and care instead? METHODS GP patient satisfaction and ED attendance data were extracted from national data warehouses and organised into two groups: (i) England clinical commissioning group (CCG) areas and (ii) a London CCG subset. Data from London CCGs were compared with CCGs outside London. RESULTS ED attendances were strongly correlated with GP patient satisfaction data in non-London CCGs, e.g. if patients said they had difficulty obtaining a convenient appointment at their general practice, then local ED attendances increased. Associations were repeated when other GP perception data were explored, e.g. if patients were satisfied with GPs and practice nurses, then they were less likely to attend their local EDs. However, these associations were not found in the London CCG subset despite lower satisfaction with London GP services. CONCLUSIONS Although our study generates valuable insights into ED attendances, the reasons why London general practice patient and ED attendance data don't show the same associations found outside London warrants further study. Diverting patients from EDs to primary care services may not be straight forward as many would like to believe.