Skip to main content
NCBI home page
The BMJ logoLink to The BMJ
. 1994 Jan 22;308(6923):249–253. doi: 10.1136/bmj.308.6923.249

Primary medical care outside normal working hours: review of published work.

L Hallam 1
PMCID: PMC2539327  PMID: 8111262

Abstract

Fundamental changes in the delivery of primary medical care outside normal surgery hours are under consideration in Great Britain. Published research into the provision and utilisation of out of hours services shows long term trends towards decreasing personal commitment among general practitioners and rising demand from patients for primary and hospital accident and emergency department care. Wide variations exist regionally, locally, and between practices. Previous studies, however, have been limited in scope and provide an inadequate basis for assessing the potential impact of change. The overall demand for care across all sources of provision cannot be measured: there is a lack of data on costs, and evaluative studies comparing alternative patterns of service delivery have rarely been undertaken. A period of experimentation and evaluation of a range of options should precede the wider adoption of any particular models.

Full text

PDF
249

Images in this article

251p251-a
on p.251

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Blair J. S., Grant J., McBride H., Martin A., Ross R. T. Casualty and surgical services in Perthshire general practitioner hospitals 1954-84. J R Coll Gen Pract. 1986 Aug;36(289):359–362. [PMC free article] [PubMed] [Google Scholar]
  2. Bollam M. J., McCarthy M., Modell M. Patient's assessment of out of hours care in general practice. Br Med J (Clin Res Ed) 1988 Mar 19;296(6625):829–832. doi: 10.1136/bmj.296.6625.829. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bowling A., Isaacs D., Armston J., Roberts J. E., Elliott E. J. Patient use of a paediatric hospital casualty department in the east end of London. Fam Pract. 1987 Jun;4(2):85–90. doi: 10.1093/fampra/4.2.85. [DOI] [PubMed] [Google Scholar]
  4. Brakenbury P. H., Jaya-Ratnam J. S. Accident and emergency services--the contribution of the community hospital. Health Trends. 1985 May;17(2):31–32. [PubMed] [Google Scholar]
  5. Buxton M. J., Klein R. E., Sayers J. Variations in GP night visiting rates: medical organisation and consumer demand. Br Med J. 1977 Mar 26;1(6064):827–830. doi: 10.1136/bmj.1.6064.827. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Calnan M. The functions of the hospital emergency department: a study of patient demand. J Emerg Med. 1984;2(1):57–63. doi: 10.1016/0736-4679(84)90049-0. [DOI] [PubMed] [Google Scholar]
  7. Calnan M. The hospital accident and emergency department: what is its role? J Soc Policy. 1982 Oct;11(4):483–503. doi: 10.1017/s0047279400022546. [DOI] [PubMed] [Google Scholar]
  8. Carlisle R. D., Johnstone S. P., Pearson J. C. Relation between night visit rates and deprivation measures in one general practice. BMJ. 1993 May 22;306(6889):1383–1385. doi: 10.1136/bmj.306.6889.1383. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Cohen J. Accident and emergency services and general practice--conflict or cooperation? Fam Pract. 1987 Jun;4(2):81–83. doi: 10.1093/fampra/4.2.81. [DOI] [PubMed] [Google Scholar]
  10. Cooper C. L., Rout U., Faragher B. Mental health, job satisfaction, and job stress among general practitioners. BMJ. 1989 Feb 11;298(6670):366–370. doi: 10.1136/bmj.298.6670.366. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Creighton P. A. Organising a practice. A case against deputising services. Br Med J (Clin Res Ed) 1982 Apr 10;284(6322):1090–1091. doi: 10.1136/bmj.284.6322.1090. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Crowe M. G., Hurwood D. S., Taylor R. W. Out-of-hours calls in a Leicestershire practice. Br Med J. 1976 Jun 26;1(6025):1582–1584. doi: 10.1136/bmj.1.6025.1582. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Cubitt T., Tobias G. Out of hours calls in general practice: does the doctor's attitude alter patient demands? Br Med J (Clin Res Ed) 1983 Jul 2;287(6384):28–30. doi: 10.1136/bmj.287.6384.28. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Cunningham R. J. Night calls in a single-handed rural practice. J R Coll Gen Pract. 1980 Dec;30(221):745–747. [PMC free article] [PubMed] [Google Scholar]
  15. Davison A. G., Hildrey A. C., Floyer M. A. Use and misuse of an accident and emergency department in the East End of London. J R Soc Med. 1983 Jan;76(1):37–40. [PMC free article] [PubMed] [Google Scholar]
  16. Dixon R. A., Williams B. T. Patient satisfaction with general practitioner deputising services. BMJ. 1988 Dec 10;297(6662):1519–1522. doi: 10.1136/bmj.297.6662.1519. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Dixon R. A., Williams B. T. Twelve months of deputising: 100 000 patient contacts with eighteen services. Br Med J. 1977 Feb 26;1(6060):560–563. doi: 10.1136/bmj.1.6060.560. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Driscoll P. A., Vincent C. A., Wilkinson M. The use of the accident and emergency department. Arch Emerg Med. 1987 Jun;4(2):77–82. doi: 10.1136/emj.4.2.77. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Fearn R. Rural health care: a British success or a tale of unmet need? Soc Sci Med. 1987;24(3):263–274. doi: 10.1016/0277-9536(87)90053-0. [DOI] [PubMed] [Google Scholar]
  20. Foroughi D., Chadwick L. Accident and emergency abusers. Practitioner. 1989 May 8;233(1468):657–659. [PubMed] [Google Scholar]
  21. Gabriel R. Emergency call service. J R Coll Gen Pract. 1976 Jan;26(162):74–75. [PMC free article] [PubMed] [Google Scholar]
  22. Grant J. A. Contribution of general practitioner hospitals in Scotland. Br Med J (Clin Res Ed) 1984 May 5;288(6427):1366–1368. doi: 10.1136/bmj.288.6427.1366. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Green J., Dale J., Glucksman E. Half the aggro. Health Serv J. 1991 Oct 24;101(5275):25–25. [PubMed] [Google Scholar]
  24. Harris A. Violence in general practice. BMJ. 1989 Jan 14;298(6666):63–64. doi: 10.1136/bmj.298.6666.63. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Hobbs F. D. Violence in general practice: a survey of general practitioners' views. BMJ. 1991 Feb 9;302(6772):329–332. doi: 10.1136/bmj.302.6772.329. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Jackson J. Paediatric primary care in inner London. J R Coll Gen Pract. 1980 Sep;30(218):520–528. [PMC free article] [PubMed] [Google Scholar]
  27. Livingstone A. E., Jewell J. A., Robson J. Twenty four hour care in inner cities: two years' out of hours workload in east London general practice. BMJ. 1989 Aug 5;299(6695):368–370. doi: 10.1136/bmj.299.6695.368. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Lockstone D. R. Night calls in a group practice. J R Coll Gen Pract. 1976 Jan;26(162):68–71. [PMC free article] [PubMed] [Google Scholar]
  29. Main J. A., Main P. G. Twenty four hour care in inner cities. BMJ. 1989 Sep 2;299(6699):627–627. doi: 10.1136/bmj.299.6699.627-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Marsh G. N., Channing D. M. Comparison in use of health services between a deprived and an endowed community. Arch Dis Child. 1987 Apr;62(4):392–396. doi: 10.1136/adc.62.4.392. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Marsh G. N., Horne R. A., Channing D. M. A study of telephone advice in managing out-of-hours calls. J R Coll Gen Pract. 1987 Jul;37(300):301–304. [PMC free article] [PubMed] [Google Scholar]
  32. McCarthy M., Bollam M. Telephone advice for out of hours calls in general practice. Br J Gen Pract. 1990 Jan;40(330):19–21. [PMC free article] [PubMed] [Google Scholar]
  33. Milner P. C., Nicholl J. P., Williams B. T. Variation in demand for accident and emergency departments in England from 1974 to 1985. J Epidemiol Community Health. 1988 Sep;42(3):274–278. doi: 10.1136/jech.42.3.274. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Morrison W. G., Pennycook A. G. A study of the content of general practitioners' referral letters to an accident and emergency department. Br J Clin Pract. 1991 Summer;45(2):95–96. [PubMed] [Google Scholar]
  35. Murray T. S., Barber J. H. The workload of a commercial deputizing service. J R Coll Gen Pract. 1977 Apr;27(177):209–211. [PMC free article] [PubMed] [Google Scholar]
  36. Myers P. Management of minor medical problems and trauma: general practice or hospital? J R Soc Med. 1982 Nov;75(11):879–883. doi: 10.1177/014107688207501111. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Myerson S. Investigating stresses in general practice using an open-ended approach in interviews. Fam Pract. 1990 Jun;7(2):91–95. doi: 10.1093/fampra/7.2.91. [DOI] [PubMed] [Google Scholar]
  38. Naidoo A. S. The doctor's deputizing service in a single-handed practice. J R Coll Gen Pract. 1982 Sep;32(242):564–566. [PMC free article] [PubMed] [Google Scholar]
  39. Nguyen-Van-Tam J. S., Baker D. M. General practice and accident and emergency department care: does the patient know best? BMJ. 1992 Jul 18;305(6846):157–158. doi: 10.1136/bmj.305.6846.157. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. O'Dwyer F., Bodiwala G. G. Unscheduled return visits by patients to the accident and emergency department. Arch Emerg Med. 1991 Sep;8(3):196–200. doi: 10.1136/emj.8.3.196. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Reilly P. M. Primary care and accident and emergency departments in an urban area. J R Coll Gen Pract. 1981 Apr;31(225):223–230. [PMC free article] [PubMed] [Google Scholar]
  46. Riddell J. A. Out-of-hours visits in a group practice. Br Med J. 1980 Jun 21;280(6230):1518–1519. doi: 10.1136/bmj.280.6230.1518. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Roland M. Deputising services. Br Med J (Clin Res Ed) 1984 Aug 25;289(6443):451–452. doi: 10.1136/bmj.289.6443.451. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Roth J. A. Some contingencies of the moral evaluation and control of clientele: the case of the hospital emergency service. AJS. 1972 Mar;77(5):839–856. doi: 10.1086/225227. [DOI] [PubMed] [Google Scholar]
  49. Sawyer L., Arber S. Organising a practice. Changes in home visiting and night and weekend cover: the patient's view. Br Med J (Clin Res Ed) 1982 May 22;284(6328):1531–1534. doi: 10.1136/bmj.284.6328.1531. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Sheldon M. G., Harris S. J. Use of deputising services and night visit rates in general practice. Br Med J (Clin Res Ed) 1984 Aug 25;289(6443):474–476. doi: 10.1136/bmj.289.6443.474. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Singh S. Self referral to accident and emergency department: patients' perceptions. BMJ. 1988 Nov 5;297(6657):1179–1180. doi: 10.1136/bmj.297.6657.1179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Stevenson J. S. Advantages of deputising services: a personal view. Br Med J (Clin Res Ed) 1982 Mar 27;284(6320):947–949. doi: 10.1136/bmj.284.6320.947. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Sutherland V. J., Cooper C. L. Job stress, satisfaction, and mental health among general practitioners before and after introduction of new contract. BMJ. 1992 Jun 13;304(6841):1545–1548. doi: 10.1136/bmj.304.6841.1545. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Telephone management of out-of-hours calls. J R Coll Gen Pract. 1988 Jan;38(306):35–36. [PMC free article] [PubMed] [Google Scholar]
  55. Tulloch A. J. 'Out of hours' calls in an Oxfordshire practice. Practitioner. 1984 Jul;228(1393):663–666. [PubMed] [Google Scholar]
  56. Usherwood T. P., Kapasi M. A., Barber J. H. Wide variations in the night visiting rate. J R Coll Gen Pract. 1985 Aug;35(277):395–395. [PMC free article] [PubMed] [Google Scholar]
  57. Whitby M., Freeman G. GPs' differing responses to out-of-hours calls. Practitioner. 1989 Apr 8;233(1466):493–495. [PubMed] [Google Scholar]
  58. Williams B. T., Dixon R. A., Nicholl J. P. Provision of first contact care out of hours in four urban areas in England. Br Med J (Clin Res Ed) 1985 Dec 14;291(6510):1689–1692. doi: 10.1136/bmj.291.6510.1689. [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Williams D. J. Patients' assessment of out of hours care. Br Med J (Clin Res Ed) 1988 Apr 23;296(6630):1197–1197. doi: 10.1136/bmj.296.6630.1197. [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Wood T. C., Cliff K. S. Accident and emergency departments--why people attend with minor injuries and ailments. Public Health. 1986 Jan;100(1):15–20. doi: 10.1016/s0033-3506(86)80081-6. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES