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Abstract
Objectives This report describes the patients who used additional out-of-hours (OOH) appointments offered through a UK scheme intended to increase patient access to primary care by extending OOH provision.
Design Cohort study and survey data.
Setting OOH appointments offered in four units in one region in England (October 2015 to November 2016).
Methods Unidentifiable data on all patients were abstracted from a bespoke appointment system and the responses to a patient opinion questionnaire about this service. Descriptive analysis of the appointment data was conducted. Multivariate analysis of the opinion survey data examined the characteristics of the patients who would have gone to the emergency department (ED) had the OOH appointments not been available.
Results There were 24 448 appointments for 19 701 different patients resulting in 29 629 service outcomes. Women dominated the uptake and patients from the poorest fifth of the population used nearly 40% of appointments. The patient survey found OOH appointments were extremely popular—93% selecting ‘extremely likely’ or ‘likely’ to recommend the service. Multivariate analysis of patient opinion survey data on whether ED would have been an alternative to the OOH service found that men, young children, people of Asian heritage and the most deprived were more likely to have gone to ED without this service.
Conclusions The users of the OOH service were substantially different from in-hours service users with a large proportion of children under age 5, and the poor, which support the idea that there may be unmet need as the poor have the least flexible working conditions. These results demonstrate the need for equality impact assessment in planning service improvements associated with policy implementation. It suggests that OOH need to take account of patients expectations about convenience of appointments and how patients use services for urgent care needs.
- general practice
- primary care
- out of hours appointments
- patient characteristics
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Footnotes
Contributors SK was the lead on the project and responsible for meeting contract deadlines, liaising with the steering group, undertaking the data analysis and took the lead on preparing this paper. SVF-D was the lead on the qualitative component of the project and contributed to the introduction and discussion. HP conducted some of the interviews in the qualitative component and helped shape the paper. RI worked with the data providers, and cleaned and coded the data and wrote the methods section. All authors reviewed and discussed multiple versions of the paper. Project managers were responsible for the contracts which delineated which data should be collected and for designing the patient opinion survey.
Funding This work was supported by a contract with Primary Care Sheffield to conduct an evaluation of the Sheffield Enhanced Primary Care Programme (SEPCP). The project reported here was one component of the SEPCP evaluation.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data used in this analysis are not in the public domain and use was covered by data sharing agreements with Primary Care Sheffield.