title: The need to improve the interface between in-hours and out-of-hours GP care, and between out-of-hours care and self-care.
abstract: BACKGROUND
  considerable changes have occurred over the last 5 years in the organization of out-of-hours care in the UK. Users' experiences of their care are an important part of 'quality of care' and are valuable for identifying areas for improvement.
  
  
  OBJECTIVE
  to identify strengths and weaknesses of out-of hours service provision in Wales. The design of the study is a cross-sectional survey. The setting of the study is nine GP services, three Accident and Emergency units and NHS Direct in Wales.
  
  
  METHODS
  survey using the validated Out-of-Hours questionnaire. We identified the four most and least favourably rated items regarding users' experience of care. These were analysed by type of care provided, telephone advice, treatment centre and home visit groups.
  
  
  RESULTS
  eight hundred and fifty-five of 3250 users responded (26% response rate). Across providers and types of care, consistent strengths were the 'manner of treatment by call operator' and the 'explanation of the next step by call operator'. Consistent weaknesses were the 'speed of call back by the clinician', the 'information provided by the GP', 'getting medication after the consultation' and 'when to contact the (in-hours) GP'.
  
  
  CONCLUSIONS
  users of out-of-hours care identify clear and consistent strengths and weaknesses of service provision across Wales. Specific areas for improvement concern the interface between in-hours care and out-of-hours care and between out-of-hours care and self-care. GP surgeries need to give better information on how to access the out-of-hours services. Out-of-hours providers should improve their advice on how and when to access in-hours surgeries and also improve the availability of medicines after out-of-hours consultations.
authors.affiliation: South East Wales Trials Unit, Department of Primary Care and Public Health, School of Medicine, Cardiff University, 2nd Floor, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS.
authors.forename: Paul
authors.initials: P
authors.lastname: Kinnersley
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Egbunike
authors.forename: Mark
authors.initials: M
authors.lastname: Kelly
authors.forename: Kerry
authors.initials: K
authors.lastname: Hood
authors.forename: Eleri
authors.initials: E
authors.lastname: Owen-Jones
authors.forename: Lori A
authors.initials: LA
authors.lastname: Button
authors.forename: Chris
authors.initials: C
authors.lastname: Shaw
authors.forename: Alison
authors.initials: A
authors.lastname: Porter
authors.forename: Helen
authors.initials: H
authors.lastname: Snooks
authors.forename: Sue
authors.initials: S
authors.lastname: Bowden
authors.forename: Adrian
authors.initials: A
authors.lastname: Edwards
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D058006:General Practice / Q000592:standards*; D006297:Health Services Accessibility / Q000592:standards; D006792:House Calls; D006801:Humans; D008297:Male; D009819:Office Visits; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D012648:Self Care; D011795:Surveys and Questionnaires; D013689:Telephone; D013997:Time Factors; D014852:Wales