Effect of introduction of integrated out of hours care in England: observational study BMJ Volume 331, pp 81-4
Newswise — NHS Direct may not have sufficient capacity to manage out of hours care in England in the way the government envisaged, finds a study published in this week's BMJ.
In 2000, the government's review of out of hours care in England recommended that patients calling their general practitioner out of hours would be automatically diverted to NHS Direct for initial assessment by telephone. A national "exemplar programme" was established to enable providers to gain experience of developing integrated services.
The study set out to quantify the extent of integration achieved in this programme and its effect on the wider health system.
The analysis involved 31 English general practice cooperatives with NHS Direct partners (exemplars). Data were collected for a year before and after integration on out of hours calls to NHS Direct and cooperatives; new attendances at emergency departments, minor injuries units, and NHS walk-in centres; and 999 ambulance transports to hospital.
Most exemplars (68%) integrated all out of hours calls during the study period, but only nine (29%) achieved single call access for all patients (an automatic diversion of a call to NHS Direct from the practice or cooperative number). Most patients still needed to make at least two telephone calls to contact NHS Direct, and then waited to be called back by a nurse.
In one exemplar, more calls were handled by a local team of cooperative nurses before integration than by NHS Direct afterwards.
Overall, there was a small but significant downturn in demand for care. Calls to emergency ambulance services increased after integration, but this may have been due to patients dialing 999 rather than waiting for a return telephone call, suggest the authors.
These results suggest that there are limited efficiencies to be gained from routing all incoming calls through NHS Direct if the workload of general practice providers is insufficiently reduced.
NHS Direct may not have the capacity to manage all out of hours demand in the way the 2000 review of out of hours care in England envisaged, they conclude.
Click here to see the full paper: http://press.psprings.co.uk/bmj/july/gp81.pdf
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