OUT-OF-HOURS SERVICE - THE DANISH SOLUTION EXAMINED

In Denmark the provision of out of hours care by general practitioners came under increasing pressure in the 1980s because of growing demand for services by the public and increasing complaints from rural docto rs about their heavy workload and disproportionately low remuneration in comparison with urban doctors. As a result, the out of hours servic e was reformed at the start of 1992: locally negotiated rota systems w ere replaced with county based services. Each county now has a coordin ation centre, where all patients' calls are received by a team of doct ors. The doctors may give a telephone consultation, advise the patient to attend one of the emergency clinics strategically placed about the county, or arrange for a home visit. Doctors on home visiting duty ar e located at bases throughout the county and keep in touch with the co ordination centre with mobile telephones. Graded fees mean that doctor s are encouraged to give telephone consultations rather than arrange f or clinic consultations or home visits. The reforms have reduced docto rs' out of hours workload and the number of home visits made and have proved acceptable to patients, doctors, and administrators.