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SURVEY OF OUT OF HOURS CARE FOR UNDER FIVES FROM TWO URBAN SCOTTISH GENERAL PRACTICES

By Simon Harbison, Ron Neville and Una MacFadyen

This is an abstract of this important survey of out of houres care for under 5s. The full version can be found here, with an additional graph (MS Excel format) here.

Objectives

To review by quantitative and qualitative methods, parental satisfaction with out of hours (OOH) care provided by NHS24 (NHS Direct in England and Wales) for their children aged five or under in an urban general practice in Scotland.

Setting

One GP practice and one out of hours centre in the East of Scotland.

Subjects

86 children aged five and under whose parents sought advice from NHS24 between December 2005 and February 2006.

Intervention

Parents who contacted NHS24, were sent a questionnaire by their GP practice. Returned questionnaires were analysed using Carstairs social deprivation scores based on postcode. A sample matrix was constructed and four parents were seen for semi structured in depth qualitative interviews. Emergent themes were recorded.

Outcomes measured

Response rates to questionnaires, clinical case mix and severity, satisfaction levels, and emergent themes following qualitative interviews.

Results

The response rate was 46%. A variation in response rate was seen between different socioeconomic groups. Those families in deprived areas, contacted NHS24 most and their response rate was lower. Although the overall parental satisfaction level of using NHS24 was good, there were areas of concern, frustration and dissatisfaction in the care provided. The clinical case mix was of a low clinical severity, with only three parents who phoned being advised to take their children to accident and emergency and four children who were seen being referred to hospital paediatric services.

Conclusion

Parents were generally satisfied with the medical care of their children 'out of hours', but complained about the time taken to phone back patients, and a perceived lack of time that the doctor spent listening and giving advice. Whether the low clinical severity of most presentations justifies time delay and lack of medical input is for society to debate, within the context of the 'inverse care law' skewing consumer response.

References

• Consumer Questionnaire, BMJ paper (BMJ 1997;314:193 (18 January)
  (Reliability and validity of a new measure of patient satisfaction with out of hours primary medical care in the united kingdom: development of a patient questionnaire)
• NHS 24 website www.nhs24.com
• The new GMS contract.
• Carstairs scores for Scottish postcode sectors from the 2001 Census - Philip McLoone, MRC social and Public Health Sciences Unit March 2004.
• Tutor Hart, J (1971) The inverse care law, Lancet :405-412.

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.