title: Impact of NHS walk-in centres on primary care access times: ecological study.
abstract: OBJECTIVE
  To examine whether walk-in centres contribute to shorter waiting times for a general practice appointment.
  
  
  METHODS
  Ecological study.
  
  
  METHODS
  2509 general practices in 56 primary care trusts in England; 32 walk-in centres within 3 km of one of these practices.
  
  
  METHODS
  Waiting time to next available general practitioner appointment (April 2003 to December 2004), from national monthly primary care access survey.
  
  
  RESULTS
  The percentage of practices achieving the target waiting time of less than 48 hours to see a general practitioner increased from 67% to 87% over the 21 month study period (adjusted odds ratio 1.07 (95% confidence interval 1.06 to 1.08) per increase in month). Achievement of the waiting time target decreased with increasing multiple deprivation (0.57 (0.49 to 0.67) for most versus least deprived third) and increased with increasing practice population size (1.02 (1.00 to 1.04) per 1000 increase). No evidence was found that increasing distance from a walk-in centre was associated with decreasing odds of achieving the waiting time target (1.00 (0.99 to 1.01) per km increase). Increasing "exposure" to a walk-in centre, modelled with a distance decay function based on attendance rates, also showed little evidence of association with achievement of the waiting time target (1.02 (0.97 to 1.08) for interquartile range increase). No evidence existed that the rate of increase in achieving the 48 hour target over time was enhanced by proximity or "exposure" to a walk-in centre. Results were similar when the analysis was rerun with data for 2003 only (done because pressure in 2004 to meet the government's deadline might have led to other changes that could have masked any walk-in centre effect).
  
  
  CONCLUSIONS
  No evidence existed that walk-in centres shortened waiting times for access to primary care, and the results do not support the use of walk-in centres for this purpose.
authors.affiliation: Public Health GIS Unit, School of Health and Related Research, University of Sheffield, Sheffield S1 4DA. r.maheswaran@sheffield.ac.uk
authors.forename: Ravi
authors.initials: R
authors.lastname: Maheswaran
authors.forename: Tim
authors.initials: T
authors.lastname: Pearson
authors.forename: James
authors.initials: J
authors.lastname: Munro
authors.forename: Moyez
authors.initials: M
authors.lastname: Jiwa
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Campbell
authors.forename: Jon
authors.initials: J
authors.lastname: Nicholl
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data / Q000600:supply & distribution*; D004739:England; D005194:Family Practice; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D012959:Socioeconomic Factors; D013222:State Medicine; D014850:Waiting Lists