24 Hour Primary Care PDF

Preface

Since 1990, a significant reorganisation of primary care services outside normal surgery hours has occurred throughout the UK. This reorganisation has been prompted by an increasing demand from patients for out-of-hours care and an increasing reluctance on the part of general practitioners to spend long and frequent periods on call. However, the UK is not alone among European nations in experiencing these problems and a variety of approaches have been tried both here and in other countries to address these issues. This book describes the antecedents of rising demand and the efforts made or suggested to manage it. The changes in service provision are critically examined, along with the impact of these changes on patients, provider organisations, costs and the health service as a whole. Finally, we examine possible directions for future developments.

A number of themes run throughout the book.

• What is the purpose of out-of-hours care? Is it 'out-of-hours' care or '24-hour' care?

• What are the needs for care? What is the current provision of services and how far does it meet the needs?

• Is demand for care changing? Why is this happening? Can or should demand be managed and if so, how?

• Are the expectations of health professionals changing and if so, why?

• What are the tensions between the expectations of the public and the health professionals? Whose perspectives matter? Are services organised for the benefit of patients or providers?

• What evidence is there about what works? What would make things work better? What are the cost and resource implications?

• How can quality be assured? How should services be monitored?

• How should care be provided? Who should organise it? At what level? Who should pay?

All these questions will be answered in the context of a health service which is undergoing rapid change. Although written from a British perspective, this book also draws on experience from Europe and the United States. It makes a unique contribution to a field which is the source of considerable controversy, but where reliable information and critical analysis of issues are hard to find. Throughout the book we have sought to include quotations (mostly from doctors) which illustrate some of the feelings that these issues have evoked.

The main focus of the book is on care provided by or on behalf of general practitioners, as these are the main providers of out-of-hours services. However, community nurses, ambulance trusts, hospital accident and emergency (A&E) departments, pharmacists and several other professional groups also provide out-of-hours care. The scope for integration of services is another important theme.

The chapters in this book are set out in three sections. The first section describes the background to the recent reorganisation of services, with an analysis of the main dilemmas which have led to the pressure for change. This includes evidence of an increasing disparity between the demands from patients and the expectations of doctors. The section concludes with a framework which describes the various models of organisation for providing out-ofhours general practice care and the claimed advantages of each.

Chapters in the second section describe the main models of organisation in turn. Each chapter considers the underlying factors which determined how and why the model developed as it did, examples of good practice, evidence from evaluations, issues to consider in planning this type of service and suggestions about where the model of care is leading.

The third section considers the future direction of out-of-hours primary care in more detail. Further consideration is given to the importance of assuring quality and the potential for integration of services. Finally, we present a practical vision for the future.

The book will be of interest to all those involved in planning and delivering out-of-hours care. This includes GPs, co-operative and deputising service managers and those involved in commissioning services or forming health policy within primary care organisations, health authorities or at a national level. The book provides a critical overview of the research evidence about the evaluation of out-of-hours services, which will be invaluable to those seeking to evaluate their own organisations, as well as those involved in research or teaching. The issues covered in this book are relevant not only to doctors but also to those involved in planning ambulance services, A&E departments or community nursing services.

The authors combine experience in organising, researching, evaluating and providing out-of-hours care. They come from a range of backgrounds and are well placed to offer practical advice, critical analysis and a political perspective. We hope that this book represents an accessible and useful contribution to the future development of this increasingly important aspect of the health service.

Author: Chris Salisbury