Article Text

Do difficulties in accessing in-hours primary care predict higher use of out-of-hours GP services? Evidence from an English National Patient Survey
  1. Yin Zhou1,
  2. Gary Abel1,
  3. Fiona Warren2,
  4. Martin Roland1,
  5. John Campbell2,
  6. Georgios Lyratzopoulos1
  1. 1Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, Cambridgeshire, UK
  2. 2Primary Care Research Group, Peninsula Medical School, Plymouth, Exeter, UK
  1. Correspondence to Dr Yin Zhou, Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, Cambridge, Cambridgeshire CB2 0SR, UK; ykz21{at}


Introduction It is believed that some patients are more likely to use out-of-hours primary care services because of difficulties in accessing in-hours care, but substantial evidence about any such association is missing.

Methods We analysed data from 567 049 respondents to the 2011/2012 English General Practice Patient Survey who reported at least one in-hours primary care consultation in the preceding 6 months. Of those respondents, 7% also reported using out-of-hours primary care. We used logistic regression to explore associations between use of out-of-hours primary care and five measures of in-hours access (ease of getting through on the telephone, ability to see a preferred general practitioner, ability to get an urgent or routine appointment and convenience of opening hours). We illustrated the potential for reduction in use of out-of-hours primary care in a model where access to in-hours care was made optimal.

Results Worse in-hours access was associated with greater use of out-of-hours primary care for each access factor. In multivariable analysis adjusting for access and patient characteristic variables, worse access was independently associated with increased out-of-hours use for all measures except ease of telephone access. Assuming these associations were causal, we estimated that an 11% relative reduction in use of out-of-hours primary care services in England could be achievable if access to in-hours care were optimal.

Conclusions This secondary quantitative analysis provides evidence for an association between difficulty in accessing in-hours care and use of out-of-hours primary care services. The findings can motivate the development of interventions to improve in-hour access.

  • Primary Care
  • Prehospital Care, Doctors in PHC
  • Prehospital Care

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