title: An observational study comparing quality of care in walk-in centres with general practice and NHS Direct using standardised patients.
abstract: OBJECTIVE
  To compare the quality of clinical care in walk-in centres with that provided in general practice and by NHS Direct.
  
  
  METHODS
  Observational study involving assessment of clinicians by standardised patients.
  
  
  METHODS
  20 walk-in centres, 20 general practices, and 11 NHS Direct sites.
  
  
  METHODS
  297 consultations with standardised patients, 99 in each setting, carried out by professional role players trained to play five clinical scenarios (postcoital contraception, chest pain, sinusitis, headache, and asthma).
  
  
  METHODS
  Primary outcomes were mean scores on consensus derived checklists of essential items for the management of the clinical scenarios. Data were also collected on access to and referral by walk-in centres, general practices, and NHS Direct.
  
  
  RESULTS
  Walk-in centres achieved a significantly greater mean score for all scenarios combined than general practices (difference between groups 8.2, 95% confidence interval 1.7 to 14.6) and NHS Direct (10.8, 5.5 to 16.1). There was considerable between scenario variation, with walk-in centres performing particularly well on postcoital contraception and asthma scenarios. In contrast to general practices, walk-in centres and NHS Direct referred a higher proportion of patients (26% and 82%, respectively).
  
  
  CONCLUSIONS
  Walk-in centres perform adequately and safely compared with general practices and NHS Direct for the range of conditions under study, but the impact of referrals on workload of other healthcare providers requires further research.
authors.affiliation: Division of Primary Health Care, University of Bristol, Bristol BS6 6JL.
authors.forename: Clare
authors.initials: C
authors.lastname: Grant
authors.forename: Ruth
authors.initials: R
authors.lastname: Nicholas
authors.forename: Laurence
authors.initials: L
authors.lastname: Moore
authors.forename: Chris
authors.initials: C
authors.lastname: Salisbury
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000592:standards*; D004739:England; D005194:Family Practice / Q000592:standards*; D005260:Female; D006297:Health Services Accessibility; D015277:Hotlines / Q000592:standards*; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013222:State Medicine / Q000458:organization & administration / Q000592:standards