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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Effect of walk-in centres
- Terry E Kenny (11 March 2003)
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Cover picture
- Jim Sikorski (11 March 2003)
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BMJ Ethics Committee guidelines on news pictures
- Richard Smith (13 March 2003)
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Health care facilities demand confidentaility too.
- Jim Sikorski (29 March 2003)
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Walk in centres
- Íomhar O' Sullivan, Rebeca Bayley (16 April 2003)
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Terry E Kenny, medical director, st helens rota 28 Hall St, St Helens WA10 1DW
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i noted with interest that your recent articles on the effect of Walk -in Centres on Primary Care workload presented results which broadly reflected those of my own study for the St Helens area. This study dealt with the impact of Walk-in Centres on Out of Hours Primary Care demand and concluded that, although Walk-in Centre attendances were rising at a steady rate, the effect on the Out of Hours workload was negligible. I hope my study, with statistical refinement, might now be accepted as a contribution to satisfying the suggestion in the second paper about drawing a more robust conclusion by evaluation over a larger number of sites. T E Kenny Competing interests: None declared |
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Jim Sikorski, GP SE26 4TH
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I trust the BMJ has on file the written consent of those patients attending the Whitechapel NHS Walk-in Centre who were portrayed on the front of the issue of 8.3.2003. They, after all, deserve the right to decide whether their attendance on health related matters is anonymous or not. Competing interests: None declared |
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Richard Smith, Editor BMJ
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The question of whether the BMJ should follow the same guidelines for news pictures as pictures emerging from the doctor-patient relationship arises repeatedly, and we have discussed it with our ethics committee. It has agreed that the two cases are quite different. This is the note from the committee: "Publication of information including photographs obtained from the public domain including wire services and news archives. This information was not obtained from the doctor-patient relationship but rather from the journalist-subject relationship. This information is in the public domain and it is ethical to republish it in BMJ. Such publication may offend some readers, as in the case of a photo of a young boy with a learning disability published alongside an article on methylphenidate (rapid responses to BMJ 2001;322:259). Editors may want to exercise discretion in publishing such information but this is a matter of etiquette, not ethics." The full consent guidelines developed by the committee can be read at: http://bmj.com/cgi/content/full/322/7297/1263/DC1/5 We welcome comments. Richard Smith
Competing interests: I'm the editor of the journal and so responsible for its policies. |
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Jim Sikorski, GP SE26 4TH
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While many attendances at a health care facility may be regarded as routine, some patients who enter a hospital or GP surgery have begun a confidential episode in their lives during which they would wish to preserve the greatest possible degree of anonymity. In order to protect those who fall into the latter category, should we not regard these facilities as protected from the ‘journalist-subject relationship’ to which Smith (1) refers? Surely the waiting room is not the same as the street? 1. Smith R BMJ Ethics Committee guidelines on news pictures. Rapid response. 13 March 2003. Competing interests: None declared |
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Íomhar O' Sullivan, Consultant in Emergency Medicine Emergency Department, Bristol Royal Infirmary, Bristol BS2 8HW, Rebeca Bayley
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Editor Neither Hsu’s [1] nor Chalder’s [2] studies have shown a significant impact of walk-in centres on the workload of nearby Emergency Departments. We suggest one reason might be a lack of patient awareness of available services. Our local walk-in centre opened 30 months ago. It is situated about a kilometre from the Bristol Royal Infirmary (BRI) and sees about 17000 patients each year. It is open every day, delivering an Emergency Nurse Practitioner service between 08:00 and 20:00 hours. We recently undertook a study of 115 adult patients in triage categories 4 and 5 who attended the BRI Emergency Department. Based on Coleman’s [3] questionnaire, we asked their reasons for attendance, and their knowledge of alternative services within the Bristol area. Our findings were in keeping with Coleman’s earlier study indicating that up to 62% could have been treated elsewhere. Patient lack of awareness of alternative services was notable. 25% knew about the existence of NHS Direct. 24% were aware of their GP Co-op out of hours service. 40% were aware of the walk-in centres. Repeated calls for better marketing of these services seems so far to have fallen on deaf ears [4]. If NHS Direct, GP Co-ops and walk-in centres are going to play a significant role in emergency care, then better efforts must be made to inform the public of the existance of such acute services. 1. Hsu R, Lambert P, Dixon-Woos M, Kurinczuk J. Effect of NHS walk-in centres on local primary healthcare services: before and after observational study. BMJ 2003;326:530 2. Chalder M, Sharp D, Moore L, Salisbury C. Impact of NHS walk-in centres on the workload of other local healthcare providers: time series analysis. BMJ 2003;326:532 3. Coleman et al. Will alternative immediate care services reduce demands for non-urgent treatment in accident and emergency? EMJ 2001;18:482-7 4. Aird P. NHGS Direct must be better marketed and deal with problems more effectively. BMJ letters 2001;322:611 Rebecca Bayley
Dr Íomhar O’ Sullivan
Competing interests: None declared |
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