• C Brogan, D Pickard, A Gray, S Fairman, and A Hill.
• Anglia and Oxford Regional Office NHS Executive, Milton Keynes.
• BMJ. 1998 Feb 14; 316 (7130): 524-7.

ObjectivesTo determine the use and costs of the principal out of hours health services in Buckinghamshire.DesignProspective cross sectional survey and cost description of patient contacts with out of hours services.SettingBuckinghamshire during March and April 1995.SubjectsGeneral practices, accident and emergency departments, ambulance services, and community nursing services.Main Outcome MeasureContacts with patients and cost of out of hours services.Results438 patient contacts/1000 population/year were recorded at an annual incremental cost of between 4.6 m Pounds and 7.2 m Pounds (depending on the costing of general practitioner services), for a population of 660,000. Of these contacts, 21,649 (45%) were with general practitioners. Night time contacts with all services diminished sharply after 10 pm. General practitioners considered that 40% of contacts were unnecessary or could have waited until morning. Over 70% of contacts were for upper respiratory tract infections, earache, gastroenteritis, and other minor ailments. Nursing care was predominantly for elderly people, and 33% of nursing contacts were to supervise medication. Accident and emergency care was predominantely for young adults, especially men, and 41% of attendances were for medical conditions.ConclusionsNew models such as multidisciplinary primary care centres with telephone advice lines and triaging are required to ensure high quality, cost effective care that is responsive to the needs of both consumers and professionals.

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