title: Creating a shared vision of out of hours care: using rapid appraisal methods to create an interagency, community oriented, approach to service development.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  A range of qualitative and quantitative survey methods based on rapid appraisal methods, modified to apply to an inner city district.
  
  
  METHODS
  Socially deprived, multiethnic district in south east London with a population of over 700,000.
  
  
  METHODS
  Strengths and weaknesses of current out of hours services and suggestions for developments.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Accident and Emergency Medicine, King's College Hospital, London.
authors.forename: J
authors.initials: J
authors.lastname: Dale
authors.forename: C
authors.initials: C
authors.lastname: Shipman
authors.forename: L
authors.initials: L
authors.lastname: Lacock
authors.forename: M
authors.initials: M
authors.lastname: Davies
mesh_terms: D001291:Attitude of Health Personnel; D003153:Community Health Services / Q000458:organization & administration* / Q000600:supply & distribution; D005194:Family Practice / Q000458:organization & administration; D006301:Health Services Needs and Demand; D006801:Humans; D007400:Interprofessional Relations; D008131:London; D010348:Patient Care Team; D011204:Poverty Areas; D011320:Primary Health Care / Q000458:organization & administration*; D019037:Urban Health Services / Q000458:organization & administration / Q000600:supply & distribution