Out Of Hours Care Research Articles

Comparison of out of hours care provided by patients' own general practitioners and commercial deputising services: a randomised controlled trial. II: the outcome of care

Objective: To compare the outcome of out of hours care given by general practitioners from patients' own practices and by commercial deputising services.Design: Randomised controlled trial.Setting: Four urban areas in...

Comparison of out of hours care provided by patients' own general practitioners and commercial deputising services: a randomised controlled trial. I: The process of care

Objectives: To compare the process of out of hours care provided by general practitioners from patients' own practices and by commercial deputising services.Design: Randomised controlled trial.Setting: Four urban areas in...

Reliability and validity of a new measure of patient satisfaction with out of hours primary medical care in the united kingdom: development of a patient questionnaire

Objective: To develop a reliable, valid measure of patient satisfaction with out of hours care suitable for large scale service evaluation.Design: Focus group meetings and semistructured interviews with patients to...

Patients' accounts of calling the doctor out of hours: qualitative study in one general practice.

To investigate patients' accounts of calling the doctor out of hours. Qualitative analysis of semi-structured interviews with two groups of patients who called their doctors out of hours from one general practice. 23 people who had called the doctor on their behalf or on behalf of another adult and 23 people who had called on behalf of a child between 6 pm and 8 am on a week day (omitting the weekend from 6 pm on Friday to 8 am on Monday). although respondents described symptoms as the main reason for the call, they also described a range of other factors that led to the call, including their feelings, concerns about specific illnesses, their responsibility for others, and their previous attempts to manage the problem themselves. They also described past experiences with health services that were important in explaining the current out of hours call or explaining their general approach to using services. The pursuit of a model of out of hours care based on medical necessity that neglects the psychosocial context of illness may not be appropriate. The importance of previous experiences of health services and contacts with health professionals in explaining current service use requires wider acknowledgement by health professionals across sectors. Separate educational programmes to encourage patients to use out of hours services more appropriately that neglect these issues may be too simplistic.

Primary care: restoring the jewel in the crown

From the mid-eighties onwards, a succession of government documents1 2 3 and policy decisions heralded a radical transformation of British general practice. The new contract was imposed in April 19904 and the NHS reforms were implemented a year later. The secretary of state for health, Stephen Dorrell, speaking in January, described the last few years as “a period of bruising management change,” in which “huge amounts of time and effort have been consumed in reorganising the management of the service.”5 This agenda of constant change and policies imposed on an unwilling profession have caused a sense of powerlessness, loss of independence, and demoralisation, which have contributed to increasing numbers of early retirements and a recruitment crisis in general practice.6 By its actions, the government showed that it no longer valued its partnership with the profession. However, the sense of alienation felt by general practitioners has been slowly assuaged over the past six years, and such recent developments as the changed arrangements for out of hours care,7 for complaints,8 9 and for health promotion10 have shown both a …

Commentary: Changing the culture of out of hours care

The Department of Health and the GMSC have breathed collective, but possibly premature, sighs of relief following the settlement reached on out of hours care. The agreed package of structural and financial measures provides the opportunity for major changes in the way in which general practitioner services are delivered out of hours. However, the extent to which the potential for change is realised depends on a broad range of factors which either did not or could not form part of the negotiating agenda. Court and colleagues' findings on factors influencing decisions to visit out of hours are an example of the latter and should be considered in the light of the settlement that was agreed. The rewording of clause 13 of general practitioners' terms and conditions of service1 has reinforced general practitioners' right to determine whether …

Responding to out of hours requests for visits: a survey of general practitioner opinion

In response to the mounting pressure of out of hours care, the terms of service for general practitioners in the NHS have been modified to emphasise that professional judgment should guide whether a consultation is required (based on the patient's medical condition) and if so, when and where the consultation should take place.1 Comprehensive searches of four literature databases revealed little about the nature and relative importance of factors which influence practitioners' judgments when responding to out of hours requests for visits. One small study found that a potentially serious diagnosis was the most common reason for out of hours visits but that in less clearcut cases the expectations and non-medical needs of patients also played a part.2 The objectives of our study were to identify the main factors which influence general practitioner …

Commentary: Changing the culture of out of hours care

Commentary: Changing the culture of out of hours care

Creating a shared vision of out of hours care: using rapid appraisal methods to create an interagency, community oriented, approach to service development

To undertake a district wide review of out of hours primary health care services and identify the views of users and providers about current arrangements and options for development. A range of qualitative and quantitative survey methods based on rapid appraisal methods, modified to apply to an inner city district. Socially deprived, multiethnic district in south east London with a population of over 700,000. Strengths and weaknesses of current out of hours services and suggestions for developments. Widespread dissatisfaction with current arrangements was identified, with specific problems relating to access, availability, demand for services, and interagency communication. Several areas for development were identified, including the establishment of an out of hours cooperative, multiagency primary care emergency centres, and telephone advice-triage. Many of these are now being planned or piloted. Rapid appraisal provided a helpful method, enabling partnerships to be established between local agencies and users in relation to service development. The shared understanding and commitment to improving services that resulted is now having a major impact on out of hours care in the district.

Organisation of primary care services outside normal working hours.

To determine the use and organisation of out of hours services in primary care. Telephone survey. Family health services authorities in England and Wales. Rate of use of out of hours care, methods of provision, and role of authorities. 12-25% of authorities were unable to answer one or more key questions in the survey because of insufficient information. The mean number of night visits made per unrestricted principal per 1000 patients per year was 35.3. 13 of the 19 authorities with averages above 40 covered large towns or cities. 81 authorities had at least one commercial deputising service. In 46 metropolitan districts and one other district over 75% of general practitioners had consent to use a deputising service, although not all did so. Information on cooperation between practices was limited. 22 cooperatives were recognised by the authorities, nine were not officially recognised, and a further 13 were nearing institution. Only two cooperatives were in areas with extensive use of deputising services. Methods of providing out of hours care are changing, and without good information systems family health services authorities will not be able to monitor the effect on quality and cost effectiveness of care.

Out of hours primary care centres: characteristics of those attending and declining to attend

To study the number, demography, and clinical details of patients who agreed or refused to attend centralised primary care centres for out of hours medical care and to study the satisfaction with the service of those who attended. Data collected by telephonists and doctors. Satisfaction questionnaires given to patients who attended. Five out of hours primary care centres in the United Kingdom. All patients contacting the deputising service to request medical help out of hours who were asked to attend a primary care centre. The study terminated when 1000 patients had agreed to attend (200 from each centre). 1000 patients not agreeing to attend were also sampled. The attendance rate varied from 8.9% to 52.3% in the five centres. The overall standardised attendance rate was 22.4%. The attendance rate was highest in children under 5 (465/2380, 19.5%) and fell with increasing age. Of the 1000 sampled non-attenders, 403 said that they had no transport and 345 said that they were too ill to attend. Those who attended were seen by the doctor more quickly. There was no significant difference between the groups in the number who received a prescription (810 attenders v 820 non-attenders, P = 0.57) or who were admitted to hospital (59 v 52, P = 0.5). Satisfaction with the service among those who attended was very high; 95% (694/731) said that they would be prepared to attend under similar circumstances in the future. Most patients are not able or prepared to attend a central facility for primary care out of hours. Substantial cultural change will be necessary and careful consideration given to planning if such centres are to provide a major part of out of hours care.

Out of hours service: the Danish solution examined

In Denmark the provision of out of hours care by general practitioners came under increasing pressure in the 1980s because of growing demand for services by the public and increasing complaints from rural doctors about their heavy workload and disproportionately low remuneration in comparison with urban doctors. As a result, the out of hours service was reformed at the start of 1992: locally negotiated rota systems were replaced with county based services. Each county now has a coordination centre, where all patients' calls are received by a team of doctors. The doctors may give a telephone consultation, advise the patient to attend one of the emergency clinics strategically placed about the county, or arrange for a home visit. Doctors on home visiting duty are located at bases throughout the county and keep in touch with the coordination centre with mobile telephones. Graded fees mean that doctors are encouraged to give telephone consultations rather than arrange for clinic consultations or home visits. The reforms have reduced doctors' out of hours workload and the number of home visits made and have proved acceptable to patients, doctors, and administrators.

GPs vote for flexibility in out of hours work

General practitioners have voted to retain 24 hour responsibility for their patients, but they want the choice of opting out of out of hours care. They have called for any agreement to give doctors the option of how they provide out of hours cover and to protect those who want to continue providing cover as at present. For the past three years the annual conference of representatives of local medical committees has debated how out of hours care should be provided. Last year the …

Patient's assessment of out of hours care in general practice.

A sample of 177 patients drawn from 13 north London practices were interviewed shortly after they had sought help from their practice outside normal surgery hours. Patients were asked to describe the process and outcome of their out of hours call, to comment on specific aspects of the consultation, and to access their overall satisfaction with the encounter. Parents seeking consultations for children were least satisfied with the consultation; those aged over 60 responded most positively. Visits from general practitioners were more acceptable than visits from deputising doctors for patients aged under 60, but for patients aged over 60 visits from general practitioners and deputising doctors were equally acceptable. Monitoring of patients' views of out of hours consultations is feasible, and the findings of this study suggest that practices should regularly review the organisation of their out of hours care and discuss strategies for minimising conflict in out of hours calls--particularly those concerning children.

Provision of first contact care out of hours in four urban areas in England.

In a typical two week period in 1984 in three urban areas with general practitioner deputising services roughly 40% of first contact patient encounters out of hours were with hospital accident and emergency departments, and only a quarter were with general practitioner deputising services, although 47%, 64%, and 97% of general practitioners in the areas had permission to use such services. Roughly a third only of the encounters were with the practices themselves, and even fewer occurred overnight (11 pm-7 am). In a fourth urban area where 68% of general practitioners formed an out of hours cooperative rota a third of the encounters were with the accident and emergency department and half (more overnight) were with the rota. The presence of a woman principal in a practice and large partnerships of four principals or more were associated with an increased proportion of encounters with the practice itself. Undue prominence may have been given to the role of deputising services in out of hours care. Paradoxically, the use of general practitioner cooperatives may result in even less personal care being given by the patient's own practice.

Quality of out of hours care: RCGP calls for working party

Quality of out of hours care: RCGP calls for working party