Out-of-hours care: two possible solutions
by Francesco Carelli
Published literature including an editorial in British Journal of General Practitioners try to answer the present costly and sometimes chaotic situation prevailing in out-of-hours care.1-3 Such literature states that what patients want is good access to reliable, authoritative, and reassuring medical advice, with the potential of addressing their needs in a way which is more appropriate to their circumstances. This is irrespective on the method of communication, ie whether it is advice given on a telephone, through face-to-face consultation or a home-visit.
Evidence-based research shows that patients consider good care simply as rapidly accessed care. The common factor is not the structure of care but the speed of response. In fact out-of-hours care is different from normal practice, where the most important factors for the latter are time for consultation and for listening which are more important than speed. So, as first point, in order to provide an optimal out-of-care service we need trained professionals able to answer to this need in a professional manner. To do this we need to train them. In Italy we created a course to specifically train doctors to cover all out-of hours during the year.
At the same time, the UK’s previous Minister of State for Health Services, Mike O’Brien, recently suggested that out-of-hours care “clearly needs further reform” and that “Regulation, in particular, needs much more central drive.”4 In the aforementioned editorial1, Campbell and Clay conclude that a new partnership is needed, one which recaptures the ethos, values and skills of evidence-based health care management, accomodating the legitimate aspirations of patients.
In Italy, these doctors trained in continuity of care, work as contract physicians and in continuing medical education, under the central drive of the NHS and are linked with the general practitioners through an established interface including an electronic exchange of records. So, immediately after the out-of-hours care provision, the General Physicians are informed about what happened to their patients. Of course, this concerns only home visits and visits carried out on Saturdays at Local Health Authorities offices.
- Campbell J, Clay H. Out-of-hours: do we? Br J Gen Pract 2010; 60:155-7.
- Egbunike J. Streamline triage and manage user expectations: lessons from a qualitative study of GP out-of-hours services. Br J Gen Pract 2010; 60:164- 5.
- Laurence C. Patient satisfaction with point-of-care testing in general practice. Br J Gen Pract. 2010; 60:166-171.
- House of Commons Official Report: Parliamentary Debates (HANSARD). 2010.;504(31).