So, what should we expect from out-of-hours care?

Out of hours care can’t seem to get much right at the moment, at least in the media. We commented only recently on the Patient’s Association report which sparked this, in which a survey (note: of their members and supporters) found that 54% “were not satisfied with the service they received from an NHS out-of-hours provider in the last 2 years”. And there is policy concern too, with Bruce Keogh’s ongoing review of urgent and emergency services. So it was interesting (and useful, as ever) to experience it myself at the weekend when my youngest child was in a bit of a state with a suspected UTI. The following tale will be wearily familiar to many of you.

It started with the usual quick chat to a call handler, and an hour wait for the nurse to call back. We were triaged, told he needed to be seen by a GP, and given an “appointment slot”. I drove forty minutes to the primary care centre (our usual surgery is two minutes’ walk away). The waiting room was bursting with cross, hysterical or simply exhausted looking people. I was advised the wait was around 1.5 hours. Two and a half hours of screaming later (my poor sick child did very well on this front, but others contributed robustly too), we were finally seen by GP. We received a careful, calm, thorough assessment, were issued with a prescription, and asked to return with a sample. I drove home, extracted what was required, and embarked on the two hour round trip to get it tested…

So, I asked myself, is this OK? What should I expect from out of hours care? My sister told me I could have just nipped to Boots to buy some dipsticks. So should I have simply bypassed the GP, and muddled through with some help from a pharmacist? A neighbour asked why I didn’t just go straight to A&E: easier to get to (12 minutes’ drive), more comprehensive care, and probably less waiting time. Of course, as a well-behaved HSR type, I knew that A&E was inappropriate for this particular episode. But dark mutters all around me in the primary care centre suggested many felt A&E would have been a far better option.

Colleagues have recently looked at the relationship between in-hours access and out-of-hours utilisation, and suggest that improving the availability of Monday to Friday GP care will reduce the numbers who choose to use urgent care (they will be presenting at the SAPC conference in Nottingham in July). It was certainly pressures of numbers that appeared to be driving the wait we endured; and in a recent radio interview one GP simply states there is a lack of support – a lack of doctors, nurses and staff to answer the phone – although the system design itself is OK. My colleagues published a paper in 2009 which outlines patients’ “high expectations” of what an out-of-hours system can provide. I will be interested to see what Keogh suggests I should expect.

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