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Effect of introduction of integrated out of hours care in England: observational study

Effect of introduction of integrated out of hours care in England: observational study
Effect of introduction of integrated out of hours care in England: observational study
Objectives: To quantify service integration achieved in the national exemplar programme for single call access to out of hours care through NHS Direct, and its effect on the wider health system.

Design: Observational before and after study of demand, activity, and trends in the use of other health services.

Participants: 34 general practice cooperatives with NHS Direct partners (exemplars): four were case exemplars; 10 control cooperatives.

Setting: England.

Main outcome measures: Extent of integration; changes in demand, activity, and trends in emergency ambulance transports; attendances at emergency departments, minor injuries units, and NHS walk-in centres; and emergency admissions to hospital in the first year.

Results: Of 31 distinct exemplars, 21 (68%) integrated all out of hours call management. Nine (29%) achieved single call access for all patients. In the only case exemplar where direct comparison was possible, a higher proportion of telephone calls were handled by cooperative nurses before integration than by NHS Direct afterwards (2622/6687 (39%) v 2092/7086 (30%): P < 0.0001). Other case exemplars did not achieve 30%. A small but significant downturn in overall demand for care seen in two case exemplars was also seen in the control cooperatives. The number of emergency ambulance transports increased in three of the four case exemplars after integration, reaching statistical significance in two (5%, -0.02% to 10%, P = 0.06; 6%, 1% to 12%, P = 0.02; 7%, 3% to 12%, P = 0.001). This was always accompanied by a significant reduction in the number of calls to the integrated service.

Conclusion: Most exemplars achieved integration of call management but not single call access for patients. Most patients made at least two telephone calls to contact NHS Direct, and then waited for a nurse to call back. Evidence for transfer of demand from case exemplars to 999 ambulance services may be amenable to change, but NHS Direct may not have sufficient capacity to support national implementation of the programme.
primary care, out of hours, england, integration
0959-8138
81-84
Lattimer, Val
5aa2c9a5-13cb-4776-9b0d-c618e6913f5b
Turnbull, Joanne
d05b07da-b692-4378-ae60-1394cd633855
Burgess, Abigail
b50e6999-9cb5-4d84-a79b-57111a45e797
Surridge, Heidi
6ad097a0-255b-4ce1-8698-32347557f6e1
Gerard, Karen
1aef0321-add2-425f-8cd6-48f1adeef928
Lathlean, Judith
98a74375-c265-47d2-b75b-5f0f3e14c1a9
Smith, Helen
42562879-cabb-497a-9209-ae8c6530b37d
George, Steve
bdfc752b-f67e-4490-8dc0-99bfaeb046ca
Lattimer, Val
5aa2c9a5-13cb-4776-9b0d-c618e6913f5b
Turnbull, Joanne
d05b07da-b692-4378-ae60-1394cd633855
Burgess, Abigail
b50e6999-9cb5-4d84-a79b-57111a45e797
Surridge, Heidi
6ad097a0-255b-4ce1-8698-32347557f6e1
Gerard, Karen
1aef0321-add2-425f-8cd6-48f1adeef928
Lathlean, Judith
98a74375-c265-47d2-b75b-5f0f3e14c1a9
Smith, Helen
42562879-cabb-497a-9209-ae8c6530b37d
George, Steve
bdfc752b-f67e-4490-8dc0-99bfaeb046ca

Lattimer, Val, Turnbull, Joanne, Burgess, Abigail, Surridge, Heidi, Gerard, Karen, Lathlean, Judith, Smith, Helen and George, Steve (2005) Effect of introduction of integrated out of hours care in England: observational study. BMJ, 331 (7508), 81-84. (doi:10.1136/bmj.331.7508.81).

Record type: Article

Abstract

Objectives: To quantify service integration achieved in the national exemplar programme for single call access to out of hours care through NHS Direct, and its effect on the wider health system.

Design: Observational before and after study of demand, activity, and trends in the use of other health services.

Participants: 34 general practice cooperatives with NHS Direct partners (exemplars): four were case exemplars; 10 control cooperatives.

Setting: England.

Main outcome measures: Extent of integration; changes in demand, activity, and trends in emergency ambulance transports; attendances at emergency departments, minor injuries units, and NHS walk-in centres; and emergency admissions to hospital in the first year.

Results: Of 31 distinct exemplars, 21 (68%) integrated all out of hours call management. Nine (29%) achieved single call access for all patients. In the only case exemplar where direct comparison was possible, a higher proportion of telephone calls were handled by cooperative nurses before integration than by NHS Direct afterwards (2622/6687 (39%) v 2092/7086 (30%): P < 0.0001). Other case exemplars did not achieve 30%. A small but significant downturn in overall demand for care seen in two case exemplars was also seen in the control cooperatives. The number of emergency ambulance transports increased in three of the four case exemplars after integration, reaching statistical significance in two (5%, -0.02% to 10%, P = 0.06; 6%, 1% to 12%, P = 0.02; 7%, 3% to 12%, P = 0.001). This was always accompanied by a significant reduction in the number of calls to the integrated service.

Conclusion: Most exemplars achieved integration of call management but not single call access for patients. Most patients made at least two telephone calls to contact NHS Direct, and then waited for a nurse to call back. Evidence for transfer of demand from case exemplars to 999 ambulance services may be amenable to change, but NHS Direct may not have sufficient capacity to support national implementation of the programme.

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More information

Published date: 9 July 2005
Additional Information: Primary care
Keywords: primary care, out of hours, england, integration

Identifiers

Local EPrints ID: 17442
URI: http://eprints.soton.ac.uk/id/eprint/17442
ISSN: 0959-8138
PURE UUID: 076d046b-1a5e-4bc6-ac7b-cff65b5a23a0

Catalogue record

Date deposited: 24 May 2006
Last modified: 08 Jan 2022 15:46

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Contributors

Author: Val Lattimer
Author: Joanne Turnbull
Author: Abigail Burgess
Author: Heidi Surridge
Author: Karen Gerard
Author: Judith Lathlean
Author: Helen Smith
Author: Steve George

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