Demand for and supply of out of hours care from general practitioners in England and Scotland: observational study based on routinely collected data

Objectives To determine the level of demand and supply of out of hours care from a nationally representative sample of general practice cooperatives. Design Observational study based on routinely collected data on telephone c alls, patient population data from general practices, and information about cooperatives from interviews with managers. Setting 20 cooperatives in England and Scotland selected after stratificati on by region and by size. Subjects 899 657 out of hours telephone calls aver 12 months. Main outcome measures Numbers and age and sex specific rates of calls; vari ation in demand and activity in relation to characteristics of the populati on; timing of calls; proportion of patients consulting at home, at a primar y care centre, or on the telephone: response times; hospital admission rate s. Results The out of hours call rate (excluding bank holidays) was 159 calls per 1000 patients/year, with rates in children aged under 5 years four time s higher than for adults. Little variation occurred by day of the week or s easonally. Cooperatives in Scotland experienced higher demand than those in England. Patients living in deprived areas made 70% more calls than those in non-deprived areas, but this had little effect on the overall variation in demand. 45.4% (408 407) of calls were handled by telephone advice. 23.6% (212 550) by a home visit and 29.8% (267 663) at a centre. Cooperatives re sponded to 60'%, of calls within 30 minutes and to 83% within one hour: Hos pital admission followed 5.5% (30 743/554 179) of out of hours calls (8 adm issions per 1000 patients/year). Conclusions This project provides national baseline data for the planning o f services and the analysis of future changes.