Changing the pattern out of hours: a survey of general practice cooperatives

Abstract

Objective: To evaluate an out of hours cooperative of general practitioners compared with a deputising service. Design: Observational study of two services in overlapping geographical areas. Setting: A general practice cooperative in Kensington, Chelsea, and Westminster and a deputising service operating in that area and the neighbouring area of Brent and Harrow. Subjects: All patients contacting a doctor at either service in an eight week period beginning 1 September 1995. Main outcome measures: Patients' age and sex; rates of home visiting, telephone advice, and attendance at a primary centre; hospital admission rates; prescribing rates; times of patient calls; and response times. Results: Data were collected on 5812 patient contacts. Doctors from the cooperative visited 32.0% (1253/ 3920) of patients, offered telephone advice to 57.8% (2267), and saw 7.1% (278) of patients at the primary care centre. By contrast, the deputising service visited 76.3% (1444/1892) of patients and gave telephone advice to 19.3% (365). Doctors from the cooperative prescribed drugs to fewer patients (37.6%; 1473/3915) than did the deputising service (51.7%; 941/1821) (odds ratio 0.56 (95% confidence interval 0.50 to 0.63) adjusted for age and sex) and admitted 8.7% (339/ 3888) of patients to hospital compared with 6.8% (128/1889) from the deputising service (odds ratio 1.30 (1.05 to 1.61) adjusted for age and sex). Response times for the deputising service were faster (median time to visit 65 minutes) than for the cooperative (median time to visit 75 minutes) but the time to first contact with a doctor was shorter for the cooperative because most people initially received telephone advice. Conclusions: The cooperative in this study dealt with patient contacts very differently from the way the deputising service dealt with contacts, fewer patients being visited and fewer receiving prescriptions. The data presented enable other out of hours services to compare their own performance using a standard data collection and analysis program.

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

“…To date, only one evaluation of a general practice out of hours cooperative has been published, and this did not give any information about costs 8. The running costs of the cooperative in our study were at the upper end of the range of development funding requirements reported in a recent brief survey of 36 cooperatives,9 but the comparability of these figures with our study is uncertain. We emphasise that the cost data presented here may not be representative of other cooperative models elsewhere in Britain.…”

Nurse telephone triage for same day appointments in general practice: multiple interrupted time series trial of effect on workload and costs

“…Much of this workload is accounted for by requests for same day appointments (urgent appointments),3 home visits,4 and out of hours calls. 5 6 Attempts to manage this workload include out of hours doctors' cooperatives7 and delegation to nurses 8 – 11. Nurses can run minor illness clinics effectively,12 and nurse practitioners provide an alternative to general practitioner care 13.…”

The effectiveness of out-of-hours dental services: I. pain relief and oral health outcome

“…'Universal access' services -intended for both registered and unregistered patients -exist in some areas, and these may use either telephone-based or 'walk-in' access arrangements, and see patients in either hospital, NHS community dental service (CDS) or general dental surgery settings. 1 Despite this diversity in the types of out-of-hours dental care available, and a wealth of studies of different models of GP-provided out-of-hours medical care, [3][4][5][6][7][8][9][10][11][12][13][14][15][16] there are no comparative studies that assess the effectiveness of emergency dental care provided in different ways. This study was originally designed to compare the cost-effectiveness of 'universal-access' out-of-hours dental care arrangements with 'conventional' out-of-hours care (that is, arrangements where there are separate service arrangements for registered and unregistered patients).…”