Demand for and supply of out of hours care from general practitioners in England and Scotland: observational study based on routinely collected data

Salisbury, Chris; Trivella, Marialena; Bruster, S.

doi:10.1136/bmj.320.7235.618

Cited by 58 publications

(52 citation statements)

References 21 publications

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“…The suggestion that "the greater accessibility of out-of-hours care, reinforced by the expansion of NHS Direct, may lead to an increase in demand for care" (Salisbury, Trivella, & Bruster 2000) is not supported by our findings. An exception to this may be those callers already exhibiting frequent attendance as part of both an in-hours and out-of-hours pattern of use (Vedsted et al 2000), but linking anonymised data in this way to GP practices was not possible within this study.…”

Section: Changes In Call Volumescontrasting

confidence: 57%

“…Monday to Friday, 6.30pm to 8.30am (54 hours per week) Friday 6:30pm to Monday 8.00am (61.5 hours per week) This local definition, which differs somewhat from that adopted by Salisbury (Salisbury, Trivella, & Bruster 2000), revealed that the total number of HARMONI out-of-hours calls which could be selected for analysis were: Data from these interviews were analysed using a grounded theory (Glaser & Strauss 1967) approach. They were then inducted to reveal themes which relate to strategy, structure, motivation, leadership, team working, role boundaries, culture and change identifying within these themes sixty sub-themes which informed both the conclusions and twenty three recommendations of the final 156-page report (Mark & Shepherd 2001).…”

Section: Methodsmentioning

confidence: 99%

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NHS Direct: managing demand for primary care?

Mark

Shepherd

2004

Health Planning & Management

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This paper considers how NHS Direct is affecting demand for primary care in particular out of hours services from GPs. This is reviewed through a three-year study of NHS Direct and HARMONI, the integrated telephone health helpline based in West London. It describes the policy background and development of the services on the site, and some of the outcomes of the HARMONI commissioned research to answer the question "Has NHS Direct increased the workload for HARMONI doctors?".The research adopted both a qualitative and quantitative approach using cross-sectional and longitudinal analysis of the data collected. The analysis of the data reveals the issues as both complex and dynamic in nature. The research shows that while there has been no significant change to the total volume of activity, changes within patient groups or GP practices may be significant. In addition, the changes in organisational arrangements may influence significant changes in referral patterns.This was confirmed for example by the changes described in the interview data on the change in nurses' role from gatekeeper to patient advocate, which happened when they ceased to be employees of the part-time co-op and began to work instead for the 24x7 NHS Direct service.The conclusions drawn are that behavioural and organisational changes are at least as significant as the evidence-based computerised decision support software in changing outcomes in the demand for primary care. Amongst the evidence cited is the different demand pattern of calls experienced by those local GPs not integrated into out-ofhours provision into NHS Direct on the West London site at the time of the study. NHS Direct : managing demand for primary care?

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Section: Changes In Call Volumescontrasting

confidence: 57%

Section: Methodsmentioning

confidence: 99%

NHS Direct: managing demand for primary care?

Mark

Shepherd

2004

Health Planning & Management

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“…Call rates were directly standardised to the out-of-hours population of a study by Salisbury et al covering 4.6 million patients (707 198 calls) across the UK, 10 providing a proxy 'English population'. The population denominator for calculating rates was derived from: registered age/sex GP patient lists; and Census 2001 population estimates at OA level (used in the geographical analysis), and at SOA level (deprivation analysis).…”

Section: How This Fits Inmentioning

confidence: 99%

“…Previous UK studies, including a large study of 20 GP cooperatives, 10 have reported rates of out-ofhours use by social and demographic characteristics. Other studies have demonstrated that patients who live further away have lower rates of use of daytime general practice, [11][12][13] emergency department, [14][15][16] and emergency hospital admissions.…”

Section: Introductionmentioning

confidence: 99%

Does distance matter? Geographical variation in GP out-of-hours service use: an observational study

Turnbull¹,

Martin²,

Lattimer³

et al. 2008

Br J Gen Pract

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BackgroundGP cooperatives are typically based in emergency primary care centres, and patients are frequently required to travel to be seen. Geography is a key determinant of access, but little is known about the extent of geographical variation in the use of out-ofhours services. AimTo examine the effects of distance and rurality on rates of out-of-hours service use. Design of studyGeographical analysis based on routinely collected data on telephone calls in June (n = 14 482) and December (n = 19 747), and area-level data. SettingOut-of-hours provider in Devon, England serving nearly 1 million patients. MethodStraight-line distance measured patients' proximity to the primary care centre. At area level, rurality was measured by Office for National Statistics Rural and Urban Classification (2004) ResultsCall rates decreased with increasing distance: 172 (95% confidence interval [CI] = 170 to 175) for the first (nearest) distance quintile, 162 (95% CI = 159 to 165) for the second, and 159 (95% CI = 156 to 162) per thousand patients/year for the third quintile. Distance and deprivation predicted call rate. Rates were highest for urban areas and lowest for sparse villages and hamlets. The greatest urban/rural variation was in patients aged 0-4 years. Rates were higher in deprived areas, but the effect of deprivation was more evident in urban than rural areas. ConclusionThere is geographical variation in out-of-hours service use. Patients from rural areas have lower call rates, but deprivation appears to be a greater determinant in urban areas. Geographical barriers must be taken into account when planning and delivering services.

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“…1,2 Literature shows that parents consult a GP on the same day when they are worried and when they discover new, unknown, or disturbing symptoms in their children. [3][4][5] Parents worry when they think that symptoms are threatening to their children, and especially when they feel they have lost control of the situation.…”

Section: Introductionmentioning

confidence: 99%