The demand for out-of-hours care from GPs: a review.

BACKGROUND: The perception of a relentless increase in demand for out-of-hours care has led to the development of new models of organization. A comprehensive review of the evidence about the demand for out-of-hours care has, however, been lacking.
OBJECTIVE: The aim of this study was to review all published work relating to out-of-hours care in UK general practice which included data about the demand for care, and the variation in demand.
METHODS: Searches were conducted in MEDLINE (1966-December 1999) and EMBASE (1988- October 1999). Further references were identified from those cited in papers, and by use of the Science Citation Index to extract articles which cited key papers. Information about night visit fee claims was also obtained from the NHS performance indicators. The review was restricted to research in the UK published since 1959. RESULTS AND
CONCLUSIONS: The activity of GPs has been used as a proxy indicator for the demand for out-of-hours primary care. Most research has been based on claims for night visit fees, which reflect only a small proportion of all out-of-hours care. Night visit rates vary widely between areas, practices and individual doctors, for reasons which remain largely unexplained. There is evidence that levels of provision of out-of-hours care have risen considerably, but the wide variation between areas, and differences between studies in terms of definition and methodology, make it difficult to confirm this finding. The recent use of electronic call management systems by general practice co-operatives allows an accurate assessment to be made from routinely collected data of the total demand for out-of-hours care. This information will make it possible to assess the impact on general practice of new models of service provision, such as NHS Direct and primary care walk-in centres.