Demand for and supply of out of hours care from general practitioners in England and Scotland: observational study based on routinely collected data.
OBJECTIVE
To determine the level of demand and supply of out of hours care from a nationally representative sample of general practice cooperatives.


METHODS
Observational study based on routinely collected data on telephone calls, patient population data from general practices, and information about cooperatives from interviews with managers.


METHODS
20 cooperatives in England and Scotland selected after stratification by region and by size.


METHODS
899 657 out of hours telephone calls over 12 months.


METHODS
Numbers and age and sex specific rates of calls; variation in demand and activity in relation to characteristics of the population; timing of calls; proportion of patients consulting at home, at a primary care centre, or on the telephone; response times; hospital admission rates.


RESULTS
The out of hours call rate (excluding bank holidays) was 159 calls per 1000 patients/year, with rates in children aged under 5 years four times higher than for adults. Little variation occurred by day of the week or seasonally. Cooperatives in Scotland experienced higher demand than those in England. Patients living in deprived areas made 70% more calls than those in non-deprived areas, but this had little effect on the overall variation in demand. 45.4% (408 407) of calls were handled by telephone advice, 23.6% (212 550) by a home visit, and 29.8% (267 663) at a centre. Cooperatives responded to 60% of calls within 30 minutes and to 83% within one hour. Hospital admission followed 5.5% (30 743/554 179) of out of hours calls (8 admissions per 1000 patients/year).


CONCLUSIONS
This project provides national baseline data for the planning of services and the analysis of future changes.
Salisbury
C
C
Division of Primary Health Care, University of Bristol, Canynge Hall, Bristol BS8 2PR. c.salisbury@bristol.ac.uk
Trivella
M
M
Bruster
S
S
D000328:Adult; D004632:Emergency Medical Services / Q000600:supply & distribution*; D005194:Family Practice / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006792:House Calls; D006801:Humans; D007400:Interprofessional Relations; D010343:Patient Admission / Q000706:statistics & numerical data; D012606:Scotland; D013997:Time Factors