Out of hours workload of a suburban general practice: deprivation or expectation.

Abstract

The out of hours workload of a training practice in a suburban and semirural area on the south coast of England was studied for one year. An overall rate of contact of 273/1000 patients was found, which indicated a workload greater than that reported in most other studies. The duty doctor received over 35 telephone calls from patients during some Saturdays (1200 Saturday to 0800 Sunday) and Sundays (0800 to 0800 Monday), up to five being between 2300 and 0700. Of the patients who contacted a general practitioner, 44% were given advice by telephone and 4 9% were admitted to hospital. The admission rate was lower than that given in other studies. A considerable proportion of the workload arose from doctors covering the casualty department of a cottage hospital. Patients having a high expectation of 24 hour care by general practitioners in an area of comparative affluence (Jarman indices -13-8 to 1.7) may account for this aspect of the workload.

The effect of deprivation on variations in general practitioners' referral rates: a cross sectional study of computerised data on new medical and surgical outpatient referrals in Nottinghamshire

“…Although we used a different measure of deprivation (that is, UPA(8)) and a different outcome related to resource usage (new outpatient referrals), our results are in broad agreement with recent work showing that morbidity, workload, and drug treatments in primary care increased with decreasing socioeconomic status 30. Our results are in contrast, however, with other studies of general practitioners' activities–for example, prescribing,31 number of consultations, and night visits32 33–showing that the UPA(8) score is a relatively poor predictor of variations and thought to be an inappropriate measure for healthcare planning and distribution of resources 34 35 36 37 38 39 40 41 42 43. The association between deprivation and high medical referral rates may simply reflect increased morbidity.…”

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

“…6 – 8 16 18 20 This may represent a change with time or the fact that earlier studies were conducted in small and often atypical (usually urban) areas. Two recent studies reporting higher rates both came from Scotland, 16 20 and our results also show high rates of calls at Scottish cooperatives.…”

“…Many studies have been based on rates of claims for night visit fees, 9 – 12 but only a small proportion of out of hours telephone calls are made at night and many out of hours calls are dealt with on the telephone and do not result in visits 13. Studies that have included telephone consultations have been local and small scale, 6 8 14 – 17 and underrecording of calls has been a further problem 18. Previous research has shown wide variation in demand, but it is difficult to compare work carried out in different years, different areas, and using different methodologies.…”

Relation of out of hours activity by general practice and accident and emergency services with deprivation in Nottingham: longitudinal survey

“…Studies of single general practices have shown high workload in deprived areas,2 3 but other studies of practices in affluent areas have also found high workloads 4. Studies of multiple practices have been able to explain only a small percentage of the variation in claims for night visits by socioeconomic factors 5 6…”