CREATING A SHARED VISION OF OUT-OF-HOURS CARE - USING RAPID APPRAISALMETHODS TO CREATE AN INTERAGENCY, COMMUNITY ORIENTED, APPROACH TO SERVICE DEVELOPMENT

Objectives-To undertake a district wide review of out of hours primary health care services and identify the views of users and providers ab out current arrangements and options for development. Design-A range o f qualitative and quantitative survey methods based on rapid appraisal methods, modified to apply to an inner city district. Setting-Sociall y deprived, multiethnic district in south east London with a populatio n of over 700 000. Main outcome measures-Strengths and weaknesses of c urrent out of hours services and suggestions for developments. Results -Widespread dissatisfaction with current arrangements was identified, with specific problems relating to access, availability, demand for se rvices, and interagency communication. Several areas for development w ere identified, including the establishment of an out of hours coopera tive, multiagency primary care emergency centres, and telephone advice -triage. Many of these are now being planned or piloted. Conclusions-R apid appraisal provided a helpful method, enabling partnerships to be established between local agencies and users in relation to service de velopment. The shared understanding and commitment to improving servic es that resulted is now having a major impact on out of hours care in the district.