Out of hours primary care is changing rapidly
[Comparison of out of hours care provided by patients' own general practitioners and commercial deputising services: a randomised controlled trial Parts I and II]
[Reliability and validity of a new measure of patient satisfaction with out of hours primary medical care in the UK: development of a patient questionnaire]
[Changing the pattern of out of hours: a survey of general practice cooperatives]
[Observational study of a general practice out of hours cooperative: measures of activity]
[Nurse telephone triage in out of hours primary care: a pilot study]
[Editorial: Out of hours primary care]
Six papers in this week's BMJ highlight the growing variability in primary care outside normal
surgery hours with increasing numbers of family doctors providing patient care via cooperative
schemes or deputising services.
Until recently, out of hours care at GP level has generally been provided by the family doctors themselves or by commercial deputising services. Yet there has never been a rigorous comparison of the two. Dr Robert McKinley, Dr David Cragg and colleagues report the findings of a randomised controlled trial and find that despite there being no difference in health outcomes between patients using deputising services and those seeing their practice doctors "out of hours", patients seen by deputising doctors were less satisfied with the care
they received. In response to a request for out of hours care, practice doctors were more likely than deputising services to offer telephone advice. When patients were visited at home, practice doctors got there sooner, and gave fewer, cheaper, and possibly more discriminating
prescriptions than deputising service doctors. No difference was found in the number or duration of hospital admissions between the two groups of doctors. Patient satisfaction is an important element of the outcome of medical care and needs to be studied, says Dr McKinley.
His team has developed a questionnaire to measure it.
Out of hours cooperatives have nearly tripled in number since 1995. A paper by Dr Jeremy Dale and colleagues reports on a survey of GP cooperatives. Findings suggest "that a substantial shift is occurring away from home visiting and towards increased telephone advice
and base consultations (where the patient travels to the doctor). While cooperatives were active in developing quality standards, there was little input from patients or health authorities.
Dr Chris Salisbury compares a GP cooperative in London with a deputising service in the overlapping area. The two services handled calls from patients differently with far more patients receiving telephone advice from the cooperative and fewer receiving prescriptions. The deputising service however carried out visits more quickly. Only 7% of patients attended the primary care centre at the cooperative.
Specially trained nurses can operate a nurse telephone triage system to receive, assess and manage incoming patient calls after surgery hours. The BMJ carries a paper on SWOOP (The South Wiltshire Out of hours Project) which piloted such a triage system. It found that nurses
could deal with over a third of calls to two general practices, thereby reducing the workload of doctors. Most patients found the service acceptable.
In an editorial, Lesley Hallam of the National Primary Care Research and Development Centre, University of Manchester, writes :"..equality of access to uniformly high standards of care is an important goal for primary health care and increasing variability in the organisation
and delivery of out of hours services should not lead to increasing inequality".
Contact:
Dr Robert McKinley
Tel: 0116 258 4367
Fax: 0116 258 4982
Dr D.K.Cragg
Tel: 0161 256 3015
or via: 0161 275 2114
Fax: 0161 256 1070
e-mail: dcragg@fsi.rgp.man.ac.uk
Dr Jeremy Dale
Tel: 0171 733 1885
Fax: 0171 501 9370
Dr Chris Salisbury
Tel: 0171 725 1075
Fax: 0171 706 8426
e-mail: c.salisbury@ic.ac.uk
Dr Steve George
Tel: 01703 796 533
Fax: 01703 796 529
e-mail: s.george@wiphm.soton.ac.uk
Lesley Hallam
Tel: 0161 275 7601
Fax: 0161 275 7600
e-mail: lhallam@fsi.cpcr.man
