Responding to out-of-hours demand: the extent and nature of urgent need

Background. Little research has been undertaken concerning GPs' perceptions about urgent or 'appropriate' out-of-hours demand. Objective. We aimed to measure GPs' perceptions about patients' need for ur gent out-of-hours general medical help according to indicators of physical, psychological/emotional and social need, and the medical necessity of a ho me visit. Methods. Twenty-five practices participated in an audit and research study whereby GPs completed an audit form for all contacts during November/Decemb er 1995 and February/March 1996. Each contact was assessed according to the indicators of urgent need and GPs commented on reasons for making such ass essments. Results. Audit forms were completed on 1862 patients, and GPs considered th at 66.6% (1027) of contacts had either a physically, psychologically/emotio nally or socially urgent need for help and were uncertain about a further 1 0.7% (165). Over half (53.0%) were considered to have an urgent physical ne ed, almost one-third (31.0%) to have an urgent psychological/emotional need and 10.1% (119) to have an urgent social need for help. Over half (55.2%) of visits were considered to be medically necessary, the majority of which (89.9%) were assessed as having an urgent physical need for help. Conclusions. The findings raise questions about the strategic direction of newer forms of service delivery (GP Go-operatives) and suggest the need for further research to inform the strategic reduction in home visiting, parti cularly in inner-city areas where many residents have little access to tran sport out-of-hours to enable them to attend a primary care centre. GP co-op eratives are, however, well placed to improve interagency working and cross -referral to other health and social service personnel, and respond more 'a ppropriately' to some psychological/emotional and social problems.