Impact of NHS Direct on demand for immediate care: observational study

doi:10.1136/bmj.321.7254.150

BMJ 2000;321:150-153 ( 15 July )

General Practice

Impact of NHS Direct on demand for immediate care: observational study

James Munro, clinical senior lecturer, Jon Nicholl, professor, Alicia O'Cathain, research fellow, Emma Knowles, research associate.

Medical Care Research Unit, University of Sheffield, Regent Court, Sheffield S1 4DA

Correspondence to: J Munro j.f.munro{at}sheffield.ac.uk

Objectives: To quantify the impact of NHS Direct on theuse of accident and emergency, ambulance, and general practitionercooperativeservices.
Design: Observational study of trends in use of NHSDirect and other immediate care services over 24 months spanningintroduction of NHSDirect.
Setting: Three areas in England in first wave of introductionof NHS Direct, and six nearby general practitioner cooperativesascontrols.
Subjects: All contacts with these immediate careservices.
Main outcome measures: Changes in trends in use after introductionof NHSDirect.
Results: NHS Direct received about 68 500 calls froma population of 1.3 million in its first year of operation, ofwhich 72% were out of hours and 22% about a child aged under 5years. Changes in trends in use of accident and emergency departmentsand ambulance services after introduction of NHS Direct were smalland non-significant. Changes in trends in use of general practitionercooperatives were also small but significant, from an increaseof 2.0% a month before introduction of NHS Direct to $-$ 0.8% afterwards(relative change $-$ 2.9% (95% confidence interval $-$ 4.2% to $-$ 1.5%)).This reduction in trend was significant both for calls handledby telephone advice alone and for those resulting in direct contactwith a doctor. In contrast, the six control cooperatives showedno evidence of change in trend; an increase of 0.8% a month beforeNHS Direct and 0.9% after (relative change 0.1% ( $-$ 0.9% to 1.1%)).
Conclusion: In its first year NHS Direct did not reducethe pressure on NHS immediate care services, although it may haverestrained increasing demand on one important part $---$ general practitioners'out of hoursservices.

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Rapid Responses:

Read all Rapid Responses

Telephone advice lines - all just hot air: Adam Harper
bmj.com, 27 Jul 2000 [Full text]
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Impact of NHS Direct on demand for immediate care.: Richard O'Brien
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