Using and providing out-of-hours services: can patients and GPs agree?

Increasing demand for primary care outside the normal working week has come into conflict with the reluctance of doctors to continue to bear 'intolerable' workloads and carry 24-h responsibility for their patients. These developments have led to widespread changes in the organization of out-of-hours primary care. This paper provides new findings on differing perceptions of use of out-of-hours primary care (general medical) services in Great Britain. By drawing on comparative data from an audit and research study on out-of-hours demand involving 25 south-east London practices, the longitudinal perspective of patients and cross sectional perspective of GPs have been identified which can lead to miscommunication during a short out-of-hours consultation. In order to achieve more effective and efficient use and provision of out-of-hours general medical services, a consensus must be developed over what emergency primary care constitutes, and the provider perspective become more accommodating in defining 'appropriate' use. Greater emphasis must also be placed on multidisciplinary working out-of-hours, to enable a more 'appropriate' response to the wide-ranging nature of demand for general medical services.