Health bulletin
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Out of hours care in the UK has undergone radical changes in the past five years, with a rapid increase in the number of general practitioner co-operatives operating from primary care centres. Patients wishing to see a general practitioner outwith normal surgery hours can now be asked to attend a centre, be given telephone advice or may still receive a home visit if required. ⋯ In particular, little is known about the continuing role of the single handed general practitioner or about out of hours care in small towns and in rural areas. The need for these issues to be addressed is discussed and the aims of the current Scottish study comparing different models of out of hours care outlined.
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To examine the trends in childhood injury mortality in Scotland between 1981 and 1995. ⋯ Childhood injury mortality rates have declined in Scotland, affecting all injury causes. The analysis of injury mortality rates in the population is helpful in highlighting potential environmental hazards that result in injury and in monitoring progress towards the achievement of national and local targets.
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To determine the impact, in terms of new attendance figures and types of patients attending, on a city centre accident and emergency (A & E) department following the establishment of out-of-hours primary care emergency centres (PCECs) in Glasgow. ⋯ Our results suggest that the new PCEC service has not had a significant impact on the number or type of patients attending this A&E department, with fewer self-referred patients contacting primary care services after its introduction. Following the introduction of the PCECs there was a trend towards more patients attending A&E following telephone advice although amongst self-referred A&E patients there remained a large proportion who claimed to be unaware of the new service 12 weeks after, and one year after, the introduction of PCECs. Continued evaluation of the effect on A&E of the new centres will be required to plan future resources for the provision of emergency care.
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To examine patterns of acute medical emergency admissions and the effect of reorganisation on their management. ⋯ Reorganisation of the medical admitting system can improve efficiency and allow reductions in staffed beds. The considerable [table: see text] variation in daily demands in the system makes it important to retain flexibility. There may be scope for dealing with the large numbers of short-term admissions in other ways.
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To determine the perceptions of managers in Scottish NHS trusts concerning bed-blocking. To help determine the causes of bed-blocking and suggest possible solutions to the problem. ⋯ Results from this study show that there would appear to be a significant number of blocked beds in NHS trust hospitals throughout Scotland. Trust staff, whilst acknowledging the complex nature of bed-blocking, perceive social services, who are responsible for the assessment, placement and financing of patients being transferred from hospitals to residential care in the community, as being responsible for the majority of these beds being blocked. It is, however, acknowledged that social services are under-funded and under-resourced. If the situation is to be improved, consideration should be given to changing service delivery processes in the context of the implementation of Designed to Care.