Improving access to GP surgeries could reduce burden on out-of-hours services

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Poor access to GP surgeries could be driving patients to use out-of-hours services and putting an extra burden on the NHS, according to researchers at the Cambridge Centre for Health Services Research. In research published today, they say that improving access could lead to an 11% reduction in the use of out-of-hours primary care services.

Improving access to regular services is not as straightforward as just extending opening hours, which current Government policies favour

Martin Roland

Out-of-hours primary care services – such as a telephone consultation followed by a home visit or attendance at an out-of-hours centre – present several disadvantages compared to in-hours services. Not only are these services more expensive to the NHS, but maintaining the high standards of care and patient experience out-of-hours is challenging. In part this is because patients using out-of-hours services will often be seen by doctors unfamiliar with their potentially complex case histories. For these reasons, modern healthcare systems aim to reduce demand for out-of-hours primary care.

In a study published in the Emergency Medicine Journal, researchers from the University of Cambridge and the University of Exeter Medical School analysed data from almost 570,000 respondents to the 2011/2012 English General Practice Patient Survey to see why people used out-of-hours services and to identify ways of reducing this burden.

The researchers found that a proportion of patients faced a number of potential barriers to accessing GP surgeries including an ability to get through to the surgery on the telephone or to get an appointment, urgent or otherwise, as well as inconvenient opening hours. The patients who experience these difficulties have a higher chance of resorting to the use of out-of-hours primary care services.

7.5% of respondents reported using out-of-hours services in the previous six months though not all of these were due to difficulties in accessing regular GP services. The researchers estimate that optimising access to in-hours services would reduce this to 6.7%, a relative reduction of 11%.

Dr Yin Zhou from the Cambridge Centre for Health Services Research says: “The use of out-of-hours services is not ideal for the patient and can be costly to the NHS. If we’re to reduce the burden on the NHS and improve patient care, then we need to make improvements in providing access to GP surgeries.”

Contrary to expectations, the researchers found that the association between out-of-hours use and the convenience of surgery opening hours was stronger amongst people in part-time than those in full-time work or education. In other words, even when opening hours suited people in part-time work, they were more likely to attend out-of-hours services than those in full-time work or education.

Professor Martin Roland, Director of the Centre, adds: “Our research suggests that improving access to regular services is not as straightforward as just extending opening hours, which current Government policies favour. Even those in part-time work can struggle to get an appointment, so offering greater availability during regular surgery hours would help reduce use of out-of-hours services.

The study was funded by the East of England Multi-Professional Deanery, the Department of Health and the National Institute of Health Research.

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