A small survey exploring patients’ experiences of out-of-hours primary care has revealed a rather gloomy picture, with many expressing anxiety about using the service and feeling that doctors are reluctant to make home visits.

The results, published in the journal Quality and Safety in Health Care, were from a set of telephone interviews conducted with 27 patients who had recently used after-hours services, and showed that telephone advice and visits to treatment centres are increasingly offered to patients instead of the traditional home visits, and that patients expressed doubts over whether a correct diagnosis could be made over the phone.

Those interviewed also voiced concern that calls were perhaps not being handled as urgently as they should, and that they had to wait to long for a call back from the doctor of visit.

Furthermore, many patients were anxious about calling the service and how appropriate their call was, not only because they were unsure of the seriousness of their situation but also because of a perception that the service was “poorly resourced and misused and they did not want to be accused of ‘abusing’ it”, the researchers said. On the plus side, there were positive remarks about the quality of care received once the initial call-handling process had been overcome.

Out-of-hours care has increasingly come under scrutiny of late, and calls are being made to boost its accessibility and quality. Last month the Royal College of Physicians highlighted the need for an expansion in the range of services, providers and facilities offering patients immediate acute medical care outside traditional hospitals, to help the growing demand for better after-hour care provision.

‘Inadequate and inflexible’
The call was spurred by the College’s new report, Acute medical care: The right person, in the right setting, first time, which stressed that out-of-hours care in the UK is “largely inadequate and inflexible,” and that this has led to a situation where patients are going to hospitals “because there is nowhere else for them to go to get the reassurance and care they need.”

Before 2004, GPs were responsible for the provision of care outside normal working hours, but a radical change was introduced into the GP contract that allowed doctors to opt out of this for a pay cut of just 6%, leaving primary care trusts with the responsibility of dealing with the approximate nine million who require such care in England every year.

Critics of the move claim that the standard and accessibility of out-of-hours has since taken a nosedive, and that it has led to an increased flow of unnecessary traffic into already stretched A&E departments. And a National Audit Office report on the standard of after hours care in England has estimated that one in five patients have negative experiences with it, further underscoring the need for a closer look at the service.