An experiment was carried out in which patients who were seeking appointments for a consultation in a general practice in south London attended consulting sessions booked at 5, 7.5, or 10 minute intervals. The particular session that the patient attended was determined non-systematically. The clinical content of the consultation was recorded on an encounter sheet and on audio-tape. At the end of each consultation patients were invited to complete a questionnaire designed to measure satisfaction with the consultation. The stress engendered in doctors carrying out surgery sessions booked at different intervals of time was also measured. At surgery sessions booked at 5 minute intervals, compared with 7.5 and 10 minute intervals, the doctors spent less time with the patients and identified fewer problems, and the patients were less satisfied with the consultation. Blood pressure was recorded twice as often in surgery sessions that were booked at 10 minute intervals compared with those booked at 5 minute intervals. There was no evidence that patients who attended sessions booked at shorter intervals received more prescriptions, were investigated or referred more often to hospital specialists, or returned more often for further consultations within four weeks. There was no evidence that the doctors experienced more stress in dealing with consultations that were booked at 5 minute intervals than at consultations booked at 7.5 and 10 minute intervals, though they complained of shortage of time more often in surgery sessions that were booked at shorter intervals.

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In a study in which patients were allocated non-systematically to surgeries booked at 5, 7.5, and 10 minute intervals 623 consultations were taperecorded. In surgeries booked at longer intervals doctors used the extra time to take a fuller history from their patients. In surgeries booked at 10 minute intervals doctors spent more time explaining the patient's problem, explaining the proposed management, and in discussing prevention and health education, these increases not being evident in surgeries booked at 7.5 minute intervals.

This paper reports on a study designed to relate certain social and psychological variables to demand for medical care in a random sample of female patients aged between 20 and 44 years, in a National Health Service General Practice in the United Kingdom. Women selected for study completed questionnaires on anxiety and on their social characteristics. They also completed a health diary for four weeks, and over 12 months their demand for general practitioner care was recorded. This paper summarizes some of the literature on the subject of utilization behaviour, describes the objectives and methodology, and gives some preliminary results suggesting associations between anxiety, perception of symptoms and demand for primary care.

Detailed referral information from one practice was used to investigate the effect of calculating refeffal rates in several different ways. Referral rates for individual general practitioners should be related to the number of consultations carried out and not to the number ofregistered patients; for whole practices list size may be used as the denominator. Most doctors will not need to control for age and sex of patients when comparing referral rates but may need to control for case mix when comparing referral rates to individual specialties. In addition, a method is described for distinguishing systematic variation between the referral rates of individual doctors from the random variation that may arise from data based on fairly small numbers of referrals. The method indicates whether systematic variation is greater than would be expected by chance, and it can be extended to indicate whether variability in referral rates is greater in one specialty than another.

Summary and conclusionsA randomised controlled trial has shown that introducing a health education booklet describing the management of six common symptoms resulted in fewer consultations for the symptoms described by families receiving this booklet compared with a control group. A sample of the mothers in each group was subsequently followed up by an interview, at which a questionnaire was administered. This was designed to measure the mother's knowledge of the management of the symptoms described. The booklet did not lead to any increase in knowledge in the mothers receiving it. The questionnaire did, however, show that 76% of the mothers had consulted the booklet at some time in the year of the study and 28% had consulted it in the three months before interview. The important result was a fall in the new requests for care for the symptoms described in the booklet. This may be interpreted as indicating that what patients need to respond appropriately to common symptoms of illness is a simple reference manual rather than an educational programme designed to increase their knowledge about the management of illness. IntroductionIn children under the age of 16 years six common symptoms accounted for over half the new requests for medical care in a London group practice.' These symptoms were a stuffy or running nose, sore throat, cough, vomiting, diarrhoea, and minor trauma. As a result of this finding, the doctors in the practice wrote a simple 16-page booklet illustrated with cartoons describing how these symptoms can be managed at home and when it is appropriate to seek medical care.

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