USING OUT-OF-HOURS SERVICES - GENERAL-PRACTICE OR A-AND-E

Background. General medical and accident and emergency (A&E) services are the two major providers of open access out-of-hours care, and ther e are widespread concerns about rising and non-urgent demand presented to both. Methods. This paper examines the differential use of these s ervices out of hours, in an audit and research study two A&E departmen ts and 21 practices in South London. It focuses on aspects of demand, including time of contact, age-related usage and nature of presenting complaints. Through interviews with a subsample of 82 patients who att ended A&E, it also provides a more qualitative focus on differential d ecision making. Results. Findings show that there are differences in t he way A&E and general medical services are used in terms of age-relat ed demand and aspects of presenting complaints. Significantly more fam ilies with children aged under 10 contacted a GP, and whilst more dige stive, respiratory and viral/non-specific complaints were presented to GPs, musculo-skeletal problems constituted the largest category of co mplaints presented at the A&E departments. However, some usage relatin g to perceived and actual availability of services appeared to be inte rchangeable in terms of site-of-help seeking. Conclusion. There is a n eed for a collaborative multi-method approach to respond to and influe nce demand.