NHS Direct must be better marketed and deal with problems more effectively

EDITOR—In their responses to the paper by Munro et al,1 who found that NHS Direct had no appreciable impact on the use of ambulance services and accident and emergency departments, McInerney et al2 and Lawson et al3 addressed two important points: do the patients know about NHS Direct; and does NHS Direct make any difference to the use of emergency services anyway? At the moment, the answer to both questions seems to be “no.”

We are studying consultations with our out of hours general practitioners' cooperative (Bridgwater Out-of-hours and Night Emergency Service, BONES), comparing the outcomes for two groups of patients who have called our service: those who have previously contacted NHS Direct about their problem and those who have not.

Preliminary results show that, of the 1153 consultations with BONES over four weeks in October, in 1005 cases (87%) the patients said they had not tried NHS Direct. We had a similar number of contacts over the same period in 1997, before NHS Direct became operational. Even if NHS Direct is preventing a small upward trend in calls out of hours,1 the fact therefore remains that most patients do not use NHS Direct.

But would it make any difference to the outcome if they did? The purpose of NHS Direct is to deal effectively with problems that can be dealt with on the telephone, …