Out of hours work in primary care: audit of an urban co-operative deputising service.

The White Paper and discussions about the GP contract have reinforced an interest in the audit of the demand for and the quality of out-of-hours cover. We audited deputising service records for the North East Deputising Service in Glasgow over one year. Six thousand eight hundred and thirty-four calls were received from a catchment population of 37,300. A sample of 468 (7%) calls was used to estimate the appropriateness of calls. A classification, based on diagnosis, classified calls as emergency, 'reasonable' or 'unnecessary'. One hundred and eighty-three out-of-hours calls were made per 1,000 patients per year, with 40 of these being at night. Twenty-three per cent of calls were considered unnecessary, 65% reasonable and 12% genuine emergencies. People living in areas of deprivation were more likely to call and more likely to make an inappropriate call. Only 1% of calls ended with telephone advice. Five per cent had to wait more than two hours after calling. The rate of calls in this study was high compared to other studies and the use of telephone advice low. Attempts should be made to make more use of telephone advice and to educate patients to make more appropriate use of services. However, the high demand from areas of deprivation should be borne in mind when calculating GP budgets.