Out of hours primary careBMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7075.157 (Published 18 January 1997) Cite this as: BMJ 1997;314:157
Variable service provision means inequalities in access and care
- Lesley Hallam, Research fellowa
- a National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL
The six papers on out of hours care published in this week's BMJ highlight the increasing variability in primary care services available to patients outside normal surgery hours. Variations in the quality and acceptability of care provided by deputising services and general practitioner rotas have long caused concern,1 but a third provider group has now entered the arena. General practitioner cooperatives have mushroomed, fuelled by general practitioners' dissatisfaction with rota commitments and financial support from the government.2 3 Unlike commercial services,4 5 6 cooperatives do not face external controls and, as Jessopp and colleagues point out (p 199),7 they vary widely in their composition and patterns of service delivery.
Giving telephone advice alone is increasingly common. Cragg and colleagues' data from 1994-5 (p 187) show that less than 1% of callers to four deputising services and 20% of callers to general practitioner rotas received telephone advice,8 which contrasts sharply with Salisbury's data for 1996, with rates of 19% for deputising service contacts and 58% for a general practitioner cooperative (p 182).9 While it would be unwise to place too much reliance on figures from one metropolitan …