The Health service journal
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Private finance schemes in primary care will not be subject to the controls required in hospital programmes. Insurance companies are interested in partnerships with primary care in order to influence NHS spending as services are increasingly contracted out. This state of affairs could lead to the introduction of US-style managed care with a loss of equity for patients.
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The last decade has seen a burgeoning of out-of-hours services in a movement characterized by experimentation and innovation that may have implications for all health services. The system needs to be more integrated to remove duplication and fill existing gaps in the service. ⋯ A shift from an out-of-hours emergency service towards 24-hour access for routine healthcare would be unsustainable and have limited health gain. NHS Direct should be the single point of access, with open access to A&E services restricted to people unable to telephone and who require urgent specialist care.
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During Christmas and new year 1999-2000 there will be eight bank holiday or weekend days. Emergency admissions are likely to be high during this period. ⋯ In this study of a 781-bed acute hospital, a minimum of 209 beds--equivalent to seven wards--will need to be empty on Christmas day. This model is derived from information on the patient administration system and could be used by all hospitals to plan care.