Primary medical care outside normal working hours: review of published work. Hallam, L. BMJ, 308(6923):249–253, January, 1994. ![Primary medical care outside normal working hours: review of published work [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper doi abstract bibtex Fundamental changes in the delivery of primary medical care outside normal surgery hours are under consideration in Great Britain. Published research into the provision and utilisation of out of hours services shows long term trends towards decreasing personal commitment among general practitioners and rising demand from patients for primary and hospital accident and emergency department care. Wide variations exist regionally, locally, and between practices. Previous studies, however, have been limited in scope and provide an inadequate basis for assessing the potential impact of change. The overall demand for care across all sources of provision cannot be measured: there is a lack of data on costs, and evaluative studies comparing alternative patterns of service delivery have rarely been undertaken. A period of experimentation and evaluation of a range of options should precede the wider adoption of any particular models. Full responsibility for the primary medical care of registered patients whenever such care is needed is a key feature of British general practice. This feature, however, has often been questioned by general practitioners. The fact that most general practitioners would prefer to replace 24 hour responsibility for their patients with a more limited commitment is not a fundamental shift in attitude but the culmination of 25 years of decreasing personal commitment and increasing reliance on rotas and commercial deputising services. Over the same time patients have increased their use of hospital accident and emergency departments as an alternative source of care. Several innovative schemes - for example, cooperatives of general practitioners, walk in emergency care centres, and the employment of general practitioners within accident and emergency departments - have been adopted or proposed to reduce the strains in the current pattern of provision of primary medical care at night and at weekends. The Department of Health is prepared in principle to see …
@article{hallam_primary_1994,
title = {Primary medical care outside normal working hours: review of published work},
volume = {308},
copyright = {© 1994 BMJ Publishing Group Ltd.},
issn = {0959-8138, 1468-5833},
shorttitle = {Primary medical care outside normal working hours},
url = {https://www-bmj-com.ezproxy.otago.ac.nz/content/308/6923/249},
doi = {10.1136/bmj.308.6923.249},
abstract = {Fundamental changes in the delivery of primary medical care outside normal surgery hours are under consideration in Great Britain. Published research into the provision and utilisation of out of hours services shows long term trends towards decreasing personal commitment among general practitioners and rising demand from patients for primary and hospital accident and emergency department care. Wide variations exist regionally, locally, and between practices. Previous studies, however, have been limited in scope and provide an inadequate basis for assessing the potential impact of change. The overall demand for care across all sources of provision cannot be measured: there is a lack of data on costs, and evaluative studies comparing alternative patterns of service delivery have rarely been undertaken. A period of experimentation and evaluation of a range of options should precede the wider adoption of any particular models.
Full responsibility for the primary medical care of registered patients whenever such care is needed is a key feature of British general practice. This feature, however, has often been questioned by general practitioners. The fact that most general practitioners would prefer to replace 24 hour responsibility for their patients with a more limited commitment is not a fundamental shift in attitude but the culmination of 25 years of decreasing personal commitment and increasing reliance on rotas and commercial deputising services. Over the same time patients have increased their use of hospital accident and emergency departments as an alternative source of care.
Several innovative schemes - for example, cooperatives of general practitioners, walk in emergency care centres, and the employment of general practitioners within accident and emergency departments - have been adopted or proposed to reduce the strains in the current pattern of provision of primary medical care at night and at weekends. The Department of Health is prepared in principle to see …},
language = {en},
number = {6923},
urldate = {2018-04-17TZ},
journal = {BMJ},
author = {Hallam, L.},
month = jan,
year = {1994},
pmid = {8111262},
keywords = {excluded, reviewed},
pages = {249--253}
}
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This feature, however, has often been questioned by general practitioners. The fact that most general practitioners would prefer to replace 24 hour responsibility for their patients with a more limited commitment is not a fundamental shift in attitude but the culmination of 25 years of decreasing personal commitment and increasing reliance on rotas and commercial deputising services. Over the same time patients have increased their use of hospital accident and emergency departments as an alternative source of care. Several innovative schemes - for example, cooperatives of general practitioners, walk in emergency care centres, and the employment of general practitioners within accident and emergency departments - have been adopted or proposed to reduce the strains in the current pattern of provision of primary medical care at night and at weekends. 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