What is the role of walk-in centres in the NHS?
BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7334.399 (Published 16 February 2002) Cite this as: BMJ 2002;324:399
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I think what is interesting from this study is the high number of
young males accessing the NHS walk in centres in comparison to GP
surgeries. There is an increased number of young men and increased
proportion of men versus women, presenting to walk in centres in the age
group 25-44.
Men are less health conscious than women for a variety of reasons, or more
reluctant to seek help and it is a problem reaching men in primary care
for prevention and health promotion work.
Walk in centres can increase access to services for men and provide a
space for education and awareness of male health issues.
I have heard that the medical profession can be paternalistic in its
attitudes, and that patient empowerment is the way to go. In a way this
seems at odds with a health system which traditionally relies on the women
in the family to pass on health advice or just nag their male members to
seek medical advice!!?? The paper stated a key feature of walk in centres
at the outset to be health promotion and supporting people to care for
themselves. This is a good opportunity to support men, in particular, to
care for themselves.
Competing interests: No competing interests
Walk in centres: the international perspective should inform evaluation
It is useful to see evaluations of NHS walk in centres (1) finally
starting to arrive. This will start to answer questions about their
accessibility and efficiency, particularly where £30 million has been
invested in this new service. With the news of the inevitable (but rare)
adverse events from other NHS primary care initiatives starting to occur,
a solid descriptive base of usage is important (2).
Salisbury et al (1) state that evidence from other healthcare
systems may have little relevance to the NHS, yet many of the same
patterns seen in the international literature are already starting to
appear. The facilities are being used by younger patients seeking episodic
care (identical to the US (3) and Canada (4). The nature of the conditions
(with upper respiratory infections predominant) and interestingly the high
level of contraception (including emergency contraception) and the use
during routine office hours are very similar. However much of this (except
the service being used by young men) sounds very like traditional NHS
general practice.
Hopefully the further evaluations (1) will not be "reinventing the
wheel" of simple descriptive studies. From the UK and international
perspective, there is a need to go on to explore important questions about
the impact of NHS walk in centres and NHS Direct. These include what the
implications are for health care demand and resource utilisation for the
NHS, the volume of "double doctoring" (4) and the impact of reduced
continuity on prescribing and referral activity. It is possibly too late
to undertake such studies for NHS Direct, which is already widely
available, but there is still an opportunity with walk in centres to
examine if they are genuinely offering additional and effective services.
Yours,
Melvyn Jones
References
1.Salisbury C, Chalder M, Manku Scott T, Pope C, Moore L. What is the role
of walk-in centres in the NHS? BMJ 2002;324:399-402
2. Carvel J. Baby death coroner criticises NHS Direct. February 15,
2002 The Guardian.
3. Rylko-Bauer B. The development and use of freestanding emergency
centers: a review of the literature. Med Care Rev. 1988 Spring; 45(1):129-
63.
4. Jones M. Walk-in primary medical care centres: lessons from
Canada. BMJ 2000; 321: 928-931.
Competing interests: author of reference 4
Competing interests: No competing interests