Relation of out of hours activity by general practice and accident and emergency services with deprivation in Nottingham: longitudinal survey
BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7130.520 (Published 14 February 1998) Cite this as: BMJ 1998;316:520
- Robin Carlisle, lecturera,
- Lindsay M Groom, research unit coordinatora,
- Anthony J Avery, senior lecturera,
- Daphne Boot, research associatea,
- Stephen Earwicker, general practitionerb
- a Division of General Practice, University of Nottingham, University Hospital, Nottingham NG7 2UH
- b Stapleford Health Centre, Nottingham NG9 7AT
- Correspondence to: Dr R Carlisle Roundwood Surgery, Wood Street, Mansfield, Nottinghamshire NG18 1QQ
- Accepted 22 October 1997
Abstract
Objectives: To investigate the relation between out of hours activity of general practice and accident and emergency services with deprivation and distance from accident and emergency department.
Design: Six month longitudinal study.
Setting: Six general practices and the sole accident and emergency department in Nottingham.
Subjects: 4745 out of hours contacts generated by 45 182 patients from 23 electoral wards registered with six practices.
Main outcome measures: Rates of out of hours contacts for general practice and accident and emergency services calculated by electoral ward; Jarman and Townsend deprivation scores and distance from accident and emergency department of electoral wards.
Results: Distances of wards from accident and emergency department ranged from 0.8 to 9 km, and Jarman deprivation scores ranged from −23.4 to 51.8. Out of hours contacts varied by ward from 110 to 350 events/1000 patients/year, and 58% of this variation was explained by the Jarman score. General practice and accident and emergency rates were positively correlated (Pearson coefficient 0.50, P=0.015). Proximity to accident and emergency department was not significantly associated with increased activity when deprivation was included in regression analysis. One practice had substantially higher out of hours activity (B coefficient 124 (95% confidence interval 67 to 181)) even when deprivation was included in regression analysis.
Conclusions: A disproportionate amount of out of hours workload fell on deprived inner city practices. High general practice and high accident and emergency activity occurred in the same areas rather than one service substituting for the other.
Key messages
We studied the out of hours activity of six general practices and the local accident and emergency department in Nottingham for six months
There were wide variations between electoral wards in both general practice and accident and emergency events
Deprivation scores explained more than half of the variation, with out of hours activity being highest in deprived inner city areas
Highly deprived areas close to the accident and emergency department generated high levels of work for both general practice and accident and emergency services, with no evidence of one service substituting for the other