About 2,000 children are treated at Oxford's casualty unit every year - but only one quarter need hospital care.

Heather Titcombe, directorate manager of the Oxford Radcliffe Hospitals NHS Trust children's and clinical genetics directorate, said the number of youngsters at the John Radcliffe Hospital accident and emergency had quadrupled in the past decade.

But three quarters of paediatric patients did not need emergency care, and could have been seen or treated elsewhere - by a GP or pharmacist.

She said: "In the last 10 years attendance has gone up four fold, and a large amount could have treatment at another site.

"We have a lot of self-admitters, who come to us instead of going to a GP or other services. About 75 per cent could be looked after in a primary care setting.

"It's purely due to the success of the four-hour wait at A and E. A few years ago, we had 24-hour waits, but now people are coming to the JR because they're worried about their children and want to be seen quickly."

Her comments, to the Oxford overview and scrutiny sub-committee, come after GP Tia MacGregor, of Jericho Health Centre, claimed children admitted to the JR A and E were moved to wards so that the hospital could meet its four- hour waiting time target.

Ms Titcombe explained that while adults in casualty were often moved to dedicated areas, like the surgical emergency unit or medical assessment unit, there were no dedicated short-term wards for children, and a shortage of paediatric staff ruled out the option.

She said: "We do have a children's emergency department and when they come in, a decision is made whether to admit them, diagnose and treat them, or send them home.

"A child who needs to stay six-12 hours will go up to a ward where they can be treated by children's nurses.

"They go to a bay specifically for short-term stays. From the feedback we've had from families, they think that's good.

"People need to be aware that there's a national recruitment issue with children's nurses, so it wouldn't be viable for us to have them in the emergency department, an observation area and the children's wards, because we wouldn't be able to deliver that."

Malcolm Fern, chairman of Oxford City Primary Care Trust - responsible for GP care - said the out-of-hours service was very efficient, but it seemed not enough people knew about it.

He said that, according to a recent survey, patients visiting Oxford Emergency Medical Service (Oxems), at St Bartholomew's Medical Centre, off Cowley Road, were seen in less than a quarter of an hour.

He said: "In Oxford City itself, the out of hours is handled by Oxford GPs and the most recent survey shows anyone seen there is seen within 14 minutes.

"Not enough people know about the service and if we can persuade people to use it that would relieve some of the pressure at the JR.

"We're continuing to work with the hospital to find ways to manage the demand."