title: Monitoring access to out-of-hours care services in Scotland - a review.
abstract: OBJECTIVE
  Changes in the contractual responsibilities of primary care practitioners and health boards have resulted in a plethora of arrangements relating to out-of-hours healthcare services. Rather than being guaranteed access to a GP (usually either their own or another through a local GP co-operative), patients have a number of alternative routes to services. Our objective was to identify and assess the availability and adequacy of relevant standards, responsibilities and information systems in Scotland to monitor the impact of contractual changes to out-of-hours healthcare services on equity of access.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  All providers of primary care out-of-hours services in Scotland.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  First, identification and policy review of current standards and performance monitoring systems, data and information, primarily through directly contacting national and local organizations responsible for monitoring out-of-hours care, supplemented by literature searches to highlight specific issues arising from the review; and second, mapping of data items by out-of-hours provider type to identify overlap and significant gaps.
  
  
  RESULTS
  In Scotland, data monitoring systems have not kept pace with changes in the organization of out-of-hours care, so the impact on access to services for different population groups is unknown. There are significant gaps in information collected with respect to workforce, distribution of services, service utilisation and clinical outcomes.
  
  
  CONCLUSIONS
  Since 2004 there have been major changes to the way patients access out-of-hours healthcare in the UK. In Scotland, none of the current systems provide information on whether the new services satisfy the key NHS principle of equity of access. There is an urgent need for a comprehensive review of data standards and systems relating to out-of-hours care in order to monitor and evaluate inputs, processes and outcomes of care not least in respect of access and fairness of distribution of resources.
authors.affiliation: Centre for International Public Health Policy, University of Edinburgh, UK. s.godden@ucl.ac.uk
authors.forename: Sylvia
authors.initials: S
authors.lastname: Godden
authors.forename: Simon
authors.initials: S
authors.lastname: Hilton
authors.forename: Allyson M
authors.initials: AM
authors.lastname: Pollock
mesh_terms: D039602:After-Hours Care / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000592:standards*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration*; D012606:Scotland