BMJ 2002;324:1556 ( 29 June )

Primary care

An observational study comparing quality of care in walk-in centres with general practice and NHS Direct using standardised patients

Clare Grant, clinical lecturer, ^a Ruth Nicholas, research associate, ^a Laurence Moore, senior research fellow, ^b Chris Salisbury, senior lecturer. ^a

^a Division of Primary Health Care, University of Bristol, Bristol BS6 6JL, ^b Cardiff School of Social Sciences, University of Cardiff, Cardiff CF10 3WT

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

Objectives: To compare the quality of clinical care in walk-in centres with that provided in general practice and by NHS Direct.
Design: Observational study involving assessment of clinicians by standardised patients.
Setting: 20 walk-in centres, 20 general practices, and 11 NHS Direct sites.
Participants: 297 consultations with standardised patients, 99 in each setting, carried out by professional role players trained to play five clinical scenarios (postcoital contraception, chest pain, sinusitis, headache, and asthma).
Main outcome measures: Primary outcomes were mean scores on consensus derived checklists of essential items for the management of the clinical scenarios. Data were also collected on access to and referral by walk-in centres, general practices, and NHS Direct.
Results: Walk-in centres achieved a significantly greater mean score for all scenarios combined than general practices (difference between groups 8.2, 95% confidence interval 1.7 to 14.6) and NHS Direct (10.8, 5.5 to 16.1). There was considerable between scenario variation, with walk-in centres performing particularly well on postcoital contraception and asthma scenarios. In contrast to general practices, walk-in centres and NHS Direct referred a higher proportion of patients (26% and 82%, respectively).
Conclusion: Walk-in centres perform adequately and safely compared with general practices and NHS Direct for the range of conditions under study, but the impact of referrals on workload of other healthcare providers requires further research.

What is already known on this topic Assessment of the quality of care provided by walk-in centres is an important part of their overall evaluation The one previous study to assess quality in this setting reported negative findings but was methodologically flawed Standardised patients are a valid and reliable method of assessment of quality of clinical care What this study adds Walk-in centres perform adequately and safely compared to general practice and NHS Direct for the range of conditions under study

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Rapid Responses:

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More information please

Mark Pasola
bmj.com, 28 Jun 2002 [Full text]

Is the high referral rate of NHS direct a cause for concern?

john sharvill
bmj.com, 1 Jul 2002 [Full text]

Performance anxiety

T Elwyn Davies
bmj.com, 2 Jul 2002 [Full text]

lies

douglas salmon
bmj.com, 4 Jul 2002 [Full text]

Was there really variation among scenarios?

Adam Jacobs
bmj.com, 9 Jul 2002 [Full text]

Only to be expected

Andrew J Cave
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Continuity of care ignored

Peter C. Arnold
bmj.com, 23 Jul 2002 [Full text]

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