Frequent service users, frequent attenders and high intensity users comprise a small proportion of emergency department (ED) visits but have a significant effect on cost and workload and are often ineffectively managed in healthcare settings. A new frequent service user manager (FSUM) service was set up in west Kent. This service used a case management approach to address the issue of frequent ED attendance and to support the well-being of these patients. To evaluate a pilot FSUM service designed to address the frequent use of urgent care services. Service data on demographics, loneliness, anxiety, quality of life and urgent care service use were obtained for 24 frequent service users in one west Kent ED. Interviews were also undertaken with a sample of these patients ( n =4) to capture their experiences of using the FSUM service. The main presenting symptoms for attending the ED were pain and alcohol-related issues. After 12 months of the FSUM service, loneliness, anxiety and use of urgent care services had reduced. The participants' quality of life improved from baseline to four months, but then stabilised at 12 months. This evaluation demonstrated the value of taking a case management approach to address the needs of frequent service users. Healthcare services must encourage the appropriate use of urgent care services to reduce system pressures, but also to improve the well-being of patients. ©2020 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.