Intended for healthcare professionals

General Practice

The use of out of hours health services: a cross sectional survey

BMJ 1998; 316 doi: (Published 14 February 1998) Cite this as: BMJ 1998;316:524
  1. Catherine Brogan, Consultant in public health medicinea,
  2. Diane Pickard, research and development specialist nurseb,
  3. Alastair Gray, directorc,
  4. Steve Fairman, information managerb,
  5. Alison Hill, director of public healthb
  1. a Anglia and Oxford Regional Office NHS Executive, Linford Wood, Milton Keynes MK14 6QP
  2. b Buckinghamshire Health Authority, Verney House, Aylesbury HP19 3ET
  3. c Health Economics Research Centre, University of Oxford, Institute of Health Sciences, Oxford OX3 7LF
  1. Correspondence to: Dr Brogan
  • Accepted 22 October 1997


Objectives: To determine the use and costs of the principal out of hours health services in Buckinghamshire.

Design: Prospective cross sectional survey and cost description of patient contacts with out of hours services.

Setting: Buckinghamshire during March and April 1995.

Subjects: General practices, accident and emergency departments, ambulance services, and community nursing services.

Main outcome measure: Contacts with patients and cost of out of hours services.

Results: 438 patient contacts/1000 population/year were recorded at an annual incremental cost of between £4.6m and £7.2m (depending on the costing of general practitioner services), for a population of 660 000. Of these contacts, 21 649 (45%) were with general practitioners. Night time contacts with all services diminished sharply after 10 pm. General practitioners considered that 40% of contacts were unnecessary or could have waited until morning. Over 70% of contacts were for upper respiratory tract infections, earache, gastroenteritis, and other minor ailments. Nursing care was predominantly for elderly people, and 33% of nursing contacts were to supervise medication. Accident and emergency care was predominately for young adults, especially men, and 41% of attendances were for medical conditions.

Conclusions: New models such as multidisciplinary primary care centres with telephone advice lines and triaging are required to ensure high quality, cost effective care that is responsive to the needs of both consumers and professionals.

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


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