General practitioners' perceptions of the appropriateness and inappropriateness of out-of-hours calls

Background: The number of out-of-hours calls to general practitioners (GPs) has increased steadily during the past 20 years. The proportion of inappro priate calls are reportedly increasing but we know very little about how GP s judge a call to be appropriate or inappropriate. Aim: To determine the factors that influence GP's perceptions of the approp riateness or inappropriateness of out-of-hours calls. Design of study: Postal questionnaire survey. Setting: GP members of the Wessex Primary Care Research Network (WReN) and the Northern Primary Care Research Network (NoReN). Method: General Practitioners were asked to write down what they meant by a n 'appropriate' and 'inappropriate' out-of-hours call. The free text was su bjected to content analysis. Results: Detailed responses were received from 146 (73%) GPs. General pract itioners appear to have a well developed classification of the appropriaten ess of out-of-hours calls. Factors that make calls appropriate include not only the nature of patients' symptoms and illness but also non-medical fact ors such as patients' compliance and politeness. Conclusion: The inclusion by GPs of non-medical factors in their conceptual isation of the appropriateness of out-of-hours calls may contribute to pati ents' confusion about what is and is not appropriate and also to the appare nt failure of patient education initiatives designed to decrease inappropri ate demand.