BMJ 1997;314:182 (18 January)

General practice

Observational study of a general practice out of hours cooperative: measures of activity

Chris Salisbury, senior lecturer in general practice a

a Department of Primary Health Care and General Practice, Imperial College School of Medicine at St Mary's, London W2 1PG

Objective: To evaluate an out of hours cooperative of general practitioners compared with a deputising service.
Design: Observational study of two services in overlapping geographical areas.
Setting: A general practice cooperative in Kensington, Chelsea, and Westminster and a deputising service operating in that area and the neighbouring area of Brent and Harrow.
Subjects: All patients contacting a doctor at either service in an eight week period beginning 1 September 1995.
Main outcome measures: Patients' age and sex; rates of home visiting, telephone advice, and attendance at a primary centre; hospital admission rates; prescribing rates; times of patient calls; and response times.
Results: Data were collected on 5812 patient contacts. Doctors from the cooperative visited 32.0% (1253/3920) of patients, offered telephone advice to 57.8% (2267), and saw 7.1% (278) of patients at the primary care centre. By contrast, the deputising service visited 76.3% (1444/1892) of patients and gave telephone advice to 19.3% (365). Doctors from the cooperative prescribed drugs to fewer patients (37.6%; 1473/3915) than did the deputising service (51.7%; 941/1821) (odds ratio 0.56 (95% confidence interval 0.50 to 0.63) adjusted for age and sex) and admitted 8.7% (339/3888) of patients to hospital compared with 6.8% (128/1889) from the deputising service (odds ratio 1.30 (1.05 to 1.61) adjusted for age and sex). Response times for the deputising service were faster (median time to visit 65 minutes) than for the cooperative (median time to visit 75 minutes) but the time to first contact with a doctor was shorter for the cooperative because most people initially received telephone advice.
Conclusions: The cooperative in this study dealt with patient contacts very differently from the way the deputising service dealt with contacts, fewer patients being visited and fewer receiving prescriptions. The data presented enable other out of hours services to compare their own performance using a standard data collection and analysis program.

Key messages

  • A primary care out of hours cooperative dealt with patients' calls very differently from an established deputising service, which may have important implications for patient satisfaction and expectations

  • Randomised controlled trials are very difficult to conduct to evaluate established services but could be planned before introducing a new service

  • The impact of a high rate of out of hours telephone advice on health outcomes should be a priority for future research

  • Few patients are currently willing or able to attend an out of hours primary care centre in London

  • Standard indicators and measurement tools should be defined to evaluate different models of out of hours care, and the results of an annual evaluation of local providers should be made available to general practitioners


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