Out-of-hours doctors reluctant to do home visits, say patients

Dec 3 2007

Patients feel that doctors providing out-of-hours services in primary care are reluctant to do home visits, shows a small study of patients' experiences in Quality and Safety in Health Care.

Researchers held group discussions and carried out telephone interviews with 27 patients who had recently used one of three services providing general practice cover in the evenings and weekends in England.

Under the new GP contract, which came into effect in 2004, most GP practices handed over responsibility for providing care out of hours to the local primary care organisation.

Instead, patients are redirected to dedicated services, which may offer telephone advice, home visits, or an appointment at a treatment centre.

Two of the services covered up to 300,000 people in three primary care trusts, while one covered almost 1 million people from eight primary care trusts.

Once patients had got through and had actually spoken to a healthcare professional, they were generally happy with the quality of service they received.

But many said they were uncertain as to the appropriateness of their call or even how the service worked.

Half said they felt guilty about calling amid fears that they might be wasting the doctor's time or “abusing the system.”

They assumed that these services had too few staff covering too wide an area and were often misused by people with minor complaints

Patients were most worried by the slow speed with which they felt cases were handled and the time it took before they were called back or a home visit was made.

Some complained that they didn't know whether to carry on waiting or seek emergency care, particularly if they were in pain or distress.

Patients thought that the non-medically qualified call handlers did not always understand the urgency of a situation, and suggested that someone with medical knowledge should be the first point of contact

Patients also felt that doctors were reluctant to carry out home visits, with many saying that the services discouraged these in favour of getting the patient to come in to a treatment centre.

Picking up medicines out of hours also posed problems, particularly for those in rural areas, or those that did not have a car.

Around 13% of people in England use an out-of-hours service, say the authors, and most of them tend to be young children, the elderly and people with complex health needs.

It's important that services monitor patients' experiences so that they can respond appropriately to these groups, they add.