Patients' unhappiness with the way they are treated by the health service out of hours often stems from a lack of information about what to expect, according to researchers at Lancaster University.
Colin Pooley and Joanna Briggs of Lancaster's department of geography and institute for health research, presenting findings to this week's annual conference of the Royal Geographical Society-Institute of British Geographers at Leicester University, said home visits by GPs were fast becoming a thing of the past. But this led to difficulties when patients rang the doctor, expecting a home visit, and did not get one.
Professor Pooley and Dr Briggs are heading a two-year study, funded by the National Health Service executive, into healthcare provision outside normal hours in two health authorities in northwest England. The health authorities and Department of Health are funding GPs to set up new systems based on higher workloads but also GPs' desire to work normal hours.
"There's a lot of variation in the way services are organised, but this reflects the way the service was set up rather than an assessment of what is appropriate or what the patients need," Professor Pooley said.
Systems often disregard the varied circumstances of patients, and while they appear to meet the needs of a majority, they may prove inconvenient or inaccessible for significant minorities, the researchers found.
Some groups of GPs form cooperatives to deliver out-of-hours care, while others hire commercial deputising services. Patients are increasingly given advice over the phone or asked to attend a primary care centre that is open outside normal hours.
"This is a rapidly changing situation where most GPs have established new systems. There is a need for GPs to publicise the system that is available and make sure patients are aware of what will happen," Professor Pooley said. "Where patients know what to expect, there is a quite high degree of satisfaction. Once patients know primary care centres exist, the reaction is favourable, and even preferred to home visits."
A home visit leaves families with nothing to do but "wait and worry", while if they could take the patient to the primary care centre, they were generally seen almost immediately, Professor Pooley said.
"All cooperatives still provide home visits for those that need them, but assuming someone is mobile, people would much rather drive to be treated than wait."
Guidelines say that patients should be seen within two hours, but Lancaster researchers found the average was between 20 and 30 minutes. They also found no big difference in waiting time between urban and rural areas. But giving information was crucial. "People were quite happy to wait if told that things were very busy and they would have to wait one-and-a-half hours," Professor Pooley said.