c Travelling to out-of-hours centres

Distances travelled to out-of-hours centres
Most patients (76%) only had to travel short distances (one to five miles) to visit the out-of-hours centres. Travelling time to the centres was a maximum of 30 minutes for most patients (96% to 100%).

"As we have transport and live quite near the centre we have no problem travelling to it."

"The only problem I have with the service is that it is so far away."

How people travelled to out-of-hours centres
Over two-thirds of the patients (68%) travelled to the centres in their own, or their parents', cars. However, 78% of the older patients (over 65 years) were given lifts to the centres or used other forms of transport.

Car ownership among adult patients and parents
The percentage of people who owned cars was highest among patients or parents who visited the centres and lowest among those who GPs visited at home. So, travel difficulties associated with not having access to a car contributed to the demand for home visits and phone advice. In particular, not owning a car was one reason why older people needed to ask for a home visit.

"I think the service offered is good but I have my own transport and can drive to the centre."

Difficulties experienced in travelling to the centres
Most of the patients and parents (77%) who visited the out-of-hours centres found it easy to travel to the centres. However, a third of the parents and patients (especially older people aged over 65) found it difficult to travel to the centres. The main reasons given for the difficulties were:

travelling was uncomfortable because of illness;

problems with finding carers to look after children or other people at home; and

problems with transport.

"It is a very good service provided the patient is able to travel to the centre."

"Elderly patients may find it more difficult in some cases and it may not be possible for the patient to travel."

"I am ninety-three years old and I am not fit to go to the surgery."

Pressure to travel to centres
Most adult patients and parents (75%) had not felt under any pressure to travel to the out-of-hours centres. However, a few of them (9%) had felt under a lot of pressure to travel to the centres. In particular, 12% to 16% of BELDOC patients and parents had felt under a lot of pressure to travel to the centres. The percentage of callers who had not felt any pressure to travel was much higher in this study than in the DALDOC survey (75% as opposed to 44%).

"I have felt pressure to travel to the centre to see the doctor."

 

 

d What patients expect from out-of-hours services

Reasons for contacting out-of-hours services
The main reason adult patients and parents who visited the centres or received home visits gave for contacting the services was that the problem was urgent. The main reasons adult patients and parents who received phone advice gave for contacting the services were that they needed advice and the problem was urgent.

"I don't contact the service unless one of my children is very sick."

"Receiving much needed advice over the phone suited us very well."

What patients expected when they contacted the services
The actual types of contact that callers received from the services (whether phone advice, visits to centres or home visits) were very similar to the types of contact they expected. In particular, most callers who expected to be visited at home did receive home visits. So, the patients' or parents' expectations influenced the type of contact the GPs provided.

"For a more serious illness, I would expect a home visit."

"in the case of my children, I expected a doctor to make a home visit."

 

 

e Whether GPs were known to patients

Only 8% of patients and parents knew the doctors who advised or treated them or their children. However, most of the patients and parents did not mind that they did not know the doctors who advised or treated them or their children.

"Home visit doctors should give their names and show ID and be a bit more pleasant and understanding."

f Actions taken by GPs

Treatment and advice given by GPs
The most common actions taken by the GPs were to provide medication or prescriptions, or give advice on how the patients or parents should treat the problems themselves or wait and see if the problems improved. Emergency actions - either sending the patient to hospital or arranging an ambulance - were the least common actions taken by the GPs. The most common actions taken by the GPs in this study were very similar to the actions taken by the GPs in the DALDOC survey.

"The doctor was very good and helpful. He done all he could but had not got any strong pain killers with him, but gave me some tablets that helped and a line to get some cream for my pain, which also helped."

Cases which patients felt were emergencies and how they felt about actions taken by GPs Where the adult patients felt that their cases were emergencies, they were generally right, as the GPs usually took urgent action. However, parents' feelings that their children's cases were emergencies were less accurate, as the GPs took urgent action less often.

"On occasions when I have contacted the centre I felt I was wasting the doctors' time and made to feel like an over-anxious mother."

g Satisfaction with out-of-hours services

Satisfaction with phone contact
Most patients and parents (95% to 96%) were satisfied with the phone contact they had with the services.

"The attention I got was first class."

"The doctor I spoke to on 12th November was extremely prompt, competent, caring and reassuring."

"I think the service would require more telephone operators. It does take a long time for the phone to be answered."

Satisfaction with waiting times
Most patients and parents were satisfied with the waiting times at the centres. 90% to 96% of them who came to the out-of-hours centres were seen by the GPs within 15 minutes.

"I am very pleased with the doctors' quick response time."

Most patients and parents who received home visits were satisfied with how long it took the GPs to arrive. In each out-of-hours service, in 34% to 67% of cases, the GPs arrived within 30 minutes. However, almost a third of the Contactors Bureau's patients and parents waited over an hour for GPs to arrive. There was also a high level of dissatisfaction with waiting times among patients and parents who used the Contactors Bureau service. The results from the DALDOC survey showed that GPs arrived within 30 minutes in 75% of the cases, compared with only 34% to 67% of the cases in this study.

"The time I spent waiting on a doctor (Ihr) was worrying and pretty stressful."

Level of advice and reassurance provided
Over three-quarters of the patients and parents said the GPs gave them a lot of advice and reassurance about their illness or their children's health problems.

"I found the doctor very easy to speak to and very reassuring."

"The doctor was very professional and gave [patient] a thorough examination. He offered a lot of scenarios on her condition, but did reassure us."

"I feel the doctor could have been more specific and reassuring concerning my daughter."

Satisfaction with treatment received
Most patients and parents who visited each centre (92% to 96%) or received home visits (88% to 97%) were satisfied with the treatment they, or their children, received. However, 12% of SEBDOC patients or parents who were visited at home were not satisfied with the treatment they received, compared with only 3% to 8% of patients or parents from other services.

"During the course of my illness, I found the home service excellent. The doctor was most professional and, immediately following examination, prescribed some medication which has helped."

Satisfaction with the overall service
Most of the patients and parents (90% to 97%) were satisfied with the overall service the out-of-hours services provided. However, parents whose children were visited at home were less satisfied than adult patients who received home visits. The levels of satisfaction with the out-of-hours services among patients or parents who visited the centres were higher than the satisfaction rate reported in the DALDOC survey (93% to 97% as opposed to 86%).

"The centre put me in touch with a doctor. He phoned back, gave advice and came to see my son. Again he gave good medical advice and I am grateful for that. However the visit was impersonal, although I do admit that the doctor appeared to be very busy - he took another telephone call during the visit."

Most patients and parents (89% to 92%) said they would use the out-of-hours services again for similar problems.