BMJ 2003;326:532 ( 8 March )

Primary care

Impact of NHS walk-in centres on the workload of other local healthcare providers: time series analysis

Melanie Chalder, senior research associate, ^a Debbie Sharp, professor of primary health care, ^b Laurence Moore, senior research fellow, ^a Chris Salisbury, reader in primary health care. ^b

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

Correspondence to:
M Chalder
chalderm{at}cardiff.ac.uk

Objectives: To assess the impact of NHS walk-in centres on the workload of local accident and emergency departments, general practices, and out of hours services.
Design: Time series analysis in walk-in centre sites with no-treatment control series in matched sites.
Setting: Walk-in centres and matched control towns without walk-in centres in England.
Participants: 20 accident and emergency departments, 40 general practices, and 14 out of hours services within 3 km of a walk-in centre or the centre of a control town.
Main outcome measures: Mean number (accident and emergency departments) or rate (general practices and out of hours services) of consultations per month in the 12 month periods before and after an index date.
Results: A reduction in consultations at emergency departments (-175 (95% confidence interval -387 to 36) consultations per department per month) and general practices (-19.8 (53.3 to 13.8) consultations per 1000 patients per month) close to walk-in centres became apparent, although these reductions were not statistically significant. Walk-in centres did not have any impact on consultations on out of hours services.
Conclusion: It will be necessary to assess the impact of walk-in centres in a larger number of sites and over a prolonged period, to determine whether they reduce the demand on other local NHS providers.

What is already known on this topic One of the objectives for NHS walk-in centres was to reduce demand on other NHS services, particularly general practitioners' services and accident and emergency departments Studies of walk-in centres in North America have indicated that such centres do not reduce demand on other healthcare services Studies of minor injuries units in the United Kingdom (which have some similarities with walk-in centres) indicate that these units substitute mainly for consultations in accident and emergency departments What this study adds The data imply that walk-in centres may moderate the increasing demand on general practice and reduce the number of consultations in accident and emergency departments The high level of background variability in consultation rates means that any impact of a walk-in centre is not statistically significant To draw robust conclusions about the impact of walk-in centres on other health providers will require study of a large number of sites over an extended period of time

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