Demand for and supply of out of hours care from general practitioners in England and Scotland: observational study based on routinely collected data

doi:10.1136/bmj.320.7235.618

BMJ 2000;320:618-621 ( 4 March )

General Practice

Demand for and supply of out of hours care from general practitioners in England and Scotland: observational study based on routinely collected data

Chris Salisbury, consultant senior lecturer, ^a Marialena Trivella, medical statistician, ^b Stephen Bruster, survey manager. ^c

^a Division of Primary Health Care, University of Bristol, Canynge Hall, Bristol BS8 2PR, ^b ICRF Medical Statistics Group, Institute of Health Sciences, Headington, Oxford OX3 7LF, ^c Picker Europe, County Mark House, London W1R 6LP

Correspondence to: C Salisbury c.salisbury{at}bristol.ac.uk

Objectives: To determine the level of demand and supplyof out of hours care from a nationally representative sample ofgeneral practicecooperatives.
Design: Observational study based on routinely collecteddata on telephone calls, patient population data from generalpractices, and information about cooperatives from interviewswithmanagers.
Setting: 20 cooperatives in England and Scotland selectedafter stratification by region and bysize.
Subjects: 899 657 out of hours telephone calls over12months.
Main outcome measures: Numbers and age and sex specific rates ofcalls; variation in demand and activity in relation to characteristicsof the population; timing of calls; proportion of patients consultingat home, at a primary care centre, or on the telephone; responsetimes; hospital admissionrates.
Results: The out of hours call rate (excluding bankholidays) was 159 calls per 1000 patients/year, with rates inchildren aged under 5 years four times higher than for adults.Little variation occurred by day of the week or seasonally. Cooperativesin Scotland experienced higher demand than those in England. Patientsliving in deprived areas made 70% more calls than those in non-deprivedareas, but this had little effect on the overall variation indemand. 45.4% (408 407) of calls were handled by telephone advice,23.6% (212 550) by a home visit, and 29.8% (267 663) at a centre.Cooperatives responded to 60% of calls within 30 minutes and to83% within one hour. Hospital admission followed 5.5% (30 743/554179) of out of hours calls (8 admissions per 1000 patients/year).
Conclusions: This project provides national baseline datafor the planning of services and the analysis of futurechanges.

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