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What is the main purpose of Walk-in Centre
- Chi K Ng (11 March 2007)
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Better access in larger practices?
- Hendrik J Beerstecher (23 April 2007)
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NHS Walk in Centres
- Daniel Boden, Dr Su Dorrian (16 May 2007)
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Chi K Ng, FY1 Doctor Dewsbury District Hopital, WF13 4HS
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There is no mention of the main purpose of the Walk-in Centres. From the article, I agreed there is no evidence that Walk-in Centres shortened waiting times for access to GP Practices. However, what is the main purpose of walk in centres? At the moment, many Walk-in Centres¡¦ main purpose is to offer treatment for minor illnesses and injuries and they can offer out of hour¡¦s services which General Practices don¡¦t. A study suggested that NHS Walk-in Centres improve access to Healthcare by opening up an alternative means of seeking a professional opinion or treatment and it showed the NHS Walk-in Centres allow people to use the NHS without feeling of increasing the burden on general practice and A&E facilities.1 Another study suggested that Walk-in Centres can reduce the A&E admissions.2 In conclusion, I think Walk-in Centres can provide another mean of primary health care service but there was some lack of clarity about the purpose of the Walk-in Centre. References: 1. A qualitative study of choosing and using an NHS Walk-in Centre Jackson et al. Fam. Pract..2005; 22: 269-274 2. Reviewing emergency care systems I: insights from system dynamics modelling Emerg Med J 2004; 21:685-691 Competing interests: None declared |
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Hendrik J Beerstecher, GP principal 111 Canterbury Road, Sittingbourne, Kent, ME10 4JA
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There are two issues that may influence access targets in relation to practice size. Firstly, deprivation and practice size are interrelated and the authors demonstrate that access targets are met by fewer practices in deprived areas. Due to the link of deprivation and practice size, deprived practices are also smaller practices. Therefore the apparent link between access targets and practice size could be due to deprivation. I presume space restrictions in the journal might have caused the absence of this in the discussion. Secondly, access gaming by using telephone triage, nurse practitioners and walk in centres was encouraged by the DH as early as 2003.(1) These diversion tactics are better suited to larger practices and this might have improved the achievement of the targets in larger practices. The MORI validation study of the DH also announced the nature of the survey before enquiring after the appointments and this would not have circumvented any access gaming by practices. 1) Anonymous. GP Bulletin - Issue 21, June 2003, DH, London. Access scheme helps cut primary care waiting times http://www.publications.doh.gov.uk/gpbulletin/issue21.htm Competing interests: HB is a principal in a small practice. |
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Daniel Boden, SpR Emergency Medicine New Cross Hospital, Wolverhampton, WV10 0QP, Dr Su Dorrian
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Dear Sir, We read with interest the article by Maheswaran et al ¹ which provides a further evaluation of the impact of NHS walk-in centres on established, first-contact, NHS services. In light of stated governmental policy to expand walk-in centres as part of an “immediate” domestic priority to improve patient access to healthcare, we believe it raises important questions. As has been shown previously waiting times for primary care remain unaltered and uninfluenced by both proximity and exposure to walk-in centres. Although this study did not look at the other elements of patient access to health care, particularly the Emergency Department, other studies have found no impact on attendance or outcome of care even in areas where walk-in centres are adjacent to Emergency Departments ². Whilst the argument that walk-in centres, in their present capacity, reduce waiting times is clearly flawed, we recognise that there are other potential benefits. The most quoted of these are that walk-in centres improve patient choice and increase accessibility of care. Even in these areas, however, as shown by qualitative research by Salisbury et al, patients seem to prefer established care pathways (ie emergency department and general practice) often in addition to consulting a walk-in centre ³. At a time of leadership change in our government, and with a key political initiative being to improve patient accessibility and choice (which we would all applaud if correctly implemented), we find it hard to justify an ever-increasing spend on an area that has so far failed to meet its own aims. Dr Su Dorrian SpR Emergency Medicine, New Cross Hospital, Wolverhampton Dr Daniel Boden, SpR Emergency Medicine, New Cross Hospital, Wolverhampton Mr Rakesh Khanna, EM Consultant, New Cross Hospital, Wolverhampton REFERENCES: 1. R Maheswaran, T Pearson, J Munro, M Jiva, M Campbell, J Nicholl "Impact of NHS Walk-in centres on primary care access times: ecological study" BMJ 2007:334:838 2. C Salisbury, S Hollinghurst, A Montgomery, M Cooke, J Munro, D Sharp, M Chalder "The Impact of co-located NHS walk-in centres on Emergency Departments" EMJ 2007 Apr24(4):265-9 3. C Salisbury, T Manku-Cott, L Moore, M Chalder, D Sharp "Questionnaire survey of users of NHS walk-in centres: observational study" Br J of Gen Pract 2002:52:554-60 Competing interests: None declared |
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