Logo of bmjLink to Publisher's site
BMJ. 1994 Jan 22; 308(6923): 249–253.
PMCID: PMC2539327

Primary medical care outside normal working hours: review of published work.


Fundamental changes in the delivery of primary medical care outside normal surgery hours are under consideration in Great Britain. Published research into the provision and utilisation of out of hours services shows long term trends towards decreasing personal commitment among general practitioners and rising demand from patients for primary and hospital accident and emergency department care. Wide variations exist regionally, locally, and between practices. Previous studies, however, have been limited in scope and provide an inadequate basis for assessing the potential impact of change. The overall demand for care across all sources of provision cannot be measured: there is a lack of data on costs, and evaluative studies comparing alternative patterns of service delivery have rarely been undertaken. A period of experimentation and evaluation of a range of options should precede the wider adoption of any particular models.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.5M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Images in this article

Click on the image to see a larger version.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Dixon RA, Williams BT. Twelve months of deputising: 100 000 patient contacts with eighteen services. Br Med J. 1977 Feb 26;1(6060):560–563. [PMC free article] [PubMed]
  • Whitby M, Freeman G. GPs' differing responses to out-of-hours calls. Practitioner. 1989 Apr 8;233(1466):493–495. [PubMed]
  • McCarthy M, Bollam M. Telephone advice for out of hours calls in general practice. Br J Gen Pract. 1990 Jan;40(330):19–21. [PMC free article] [PubMed]
  • Cubitt T, Tobias G. Out of hours calls in general practice: does the doctor's attitude alter patient demands? Br Med J (Clin Res Ed) 1983 Jul 2;287(6384):28–30. [PMC free article] [PubMed]
  • Sheldon MG, Harris SJ. Use of deputising services and night visit rates in general practice. Br Med J (Clin Res Ed) 1984 Aug 25;289(6443):474–476. [PMC free article] [PubMed]
  • Livingstone AE, Jewell JA, Robson J. Twenty four hour care in inner cities: two years' out of hours workload in east London general practice. BMJ. 1989 Aug 5;299(6695):368–370. [PMC free article] [PubMed]
  • Crowe MG, Hurwood DS, Taylor RW. Out-of-hours calls in a Leicestershire practice. Br Med J. 1976 Jun 26;1(6025):1582–1584. [PMC free article] [PubMed]
  • Sawyer L, Arber S. Organising a practice. Changes in home visiting and night and weekend cover: the patient's view. Br Med J (Clin Res Ed) 1982 May 22;284(6328):1531–1534. [PMC free article] [PubMed]
  • Prudhoe Rosemary H. Deputising services. Br Med J (Clin Res Ed) 1984 Mar 03;288(6418):b718–718. [PMC free article]
  • Stevenson JS. Advantages of deputising services: a personal view. Br Med J (Clin Res Ed) 1982 Mar 27;284(6320):947–949. [PMC free article] [PubMed]
  • Cooper CL, Rout U, Faragher B. Mental health, job satisfaction, and job stress among general practitioners. BMJ. 1989 Feb 11;298(6670):366–370. [PMC free article] [PubMed]
  • Creighton PA. Organising a practice. A case against deputising services. Br Med J (Clin Res Ed) 1982 Apr 10;284(6322):1090–1091. [PMC free article] [PubMed]
  • Roland M. Deputising services. Br Med J (Clin Res Ed) 1984 Aug 25;289(6443):451–452. [PMC free article] [PubMed]
  • Murray TS, Barber JH. The workload of a commercial deputizing service. J R Coll Gen Pract. 1977 Apr;27(177):209–211. [PMC free article] [PubMed]
  • Gabriel R. Emergency call service. J R Coll Gen Pract. 1976 Jan;26(162):74–75. [PMC free article] [PubMed]
  • Buxton MJ, Klein RE, Sayers J. Variations in GP night visiting rates: medical organisation and consumer demand. Br Med J. 1977 Mar 26;1(6064):827–830. [PMC free article] [PubMed]
  • Naidoo AS. The doctor's deputizing service in a single-handed practice. J R Coll Gen Pract. 1982 Sep;32(242):564–566. [PMC free article] [PubMed]
  • Dixon RA, Williams BT. Patient satisfaction with general practitioner deputising services. BMJ. 1988 Dec 10;297(6662):1519–1522. [PMC free article] [PubMed]
  • Bollam MJ, McCarthy M, Modell M. Patient's assessment of out of hours care in general practice. Br Med J (Clin Res Ed) 1988 Mar 19;296(6625):829–832. [PMC free article] [PubMed]
  • Myerson S. Investigating stresses in general practice using an open-ended approach in interviews. Fam Pract. 1990 Jun;7(2):91–95. [PubMed]
  • Sutherland VJ, Cooper CL. Job stress, satisfaction, and mental health among general practitioners before and after introduction of new contract. BMJ. 1992 Jun 13;304(6841):1545–1548. [PMC free article] [PubMed]
  • Harris A. Violence in general practice. BMJ. 1989 Jan 14;298(6666):63–64. [PMC free article] [PubMed]
  • Hobbs FD. Violence in general practice: a survey of general practitioners' views. BMJ. 1991 Feb 9;302(6772):329–332. [PMC free article] [PubMed]
  • Lockstone DR. Night calls in a group practice. J R Coll Gen Pract. 1976 Jan;26(162):68–71. [PMC free article] [PubMed]
  • Styles W McN. Out-of-hours experience for general practitioner trainees. J R Coll Gen Pract. 1983 Jul;33(252):395–396. [PMC free article]
  • Gadsby Roger. Telephone advice in managing out-of-hours calls. J R Coll Gen Pract. 1987 Oct;37(303):b462–462. [PMC free article]
  • Marsh GN, Horne RA, Channing DM. A study of telephone advice in managing out-of-hours calls. J R Coll Gen Pract. 1987 Jul;37(300):301–304. [PMC free article] [PubMed]
  • Telephone management of out-of-hours calls. J R Coll Gen Pract. 1988 Jan;38(306):35–36. [PMC free article] [PubMed]
  • Riddell JA. Out-of-hours visits in a group practice. Br Med J. 1980 Jun 21;280(6230):1518–1519. [PMC free article] [PubMed]
  • Cunningham RJ. Night calls in a single-handed rural practice. J R Coll Gen Pract. 1980 Dec;30(221):745–747. [PMC free article] [PubMed]
  • Barley SL. NIGHT CALLS IN GROUP PRACTICE. J R Coll Gen Pract. 1979 Dec;29(209):752–753. [PMC free article]
  • Usherwood TP, Kapasi MA, Barber JH. Wide variations in the night visiting rate. J R Coll Gen Pract. 1985 Aug;35(277):395–395. [PMC free article] [PubMed]
  • Williams BT, Dixon RA, Nicholl JP. Provision of first contact care out of hours in four urban areas in England. Br Med J (Clin Res Ed) 1985 Dec 14;291(6510):1689–1692. [PMC free article] [PubMed]
  • Davison AG, Hildrey AC, Floyer MA. Use and misuse of an accident and emergency department in the East End of London. J R Soc Med. 1983 Jan;76(1):37–40. [PMC free article] [PubMed]
  • Foroughi D, Chadwick L. Accident and emergency abusers. Practitioner. 1989 May 8;233(1468):657–659. [PubMed]
  • Wood TC, Cliff KS. Accident and emergency departments--why people attend with minor injuries and ailments. Public Health. 1986 Jan;100(1):15–20. [PubMed]
  • Driscoll PA, Vincent CA, Wilkinson M. The use of the accident and emergency department. Arch Emerg Med. 1987 Jun;4(2):77–82. [PMC free article] [PubMed]
  • Bowling A, Isaacs D, Armston J, Roberts JE, Elliott EJ. Patient use of a paediatric hospital casualty department in the east end of London. Fam Pract. 1987 Jun;4(2):85–90. [PubMed]
  • Jackson J. Paediatric primary care in inner London. J R Coll Gen Pract. 1980 Sep;30(218):520–528. [PMC free article] [PubMed]
  • Milner PC, Nicholl JP, Williams BT. Variation in demand for accident and emergency departments in England from 1974 to 1985. J Epidemiol Community Health. 1988 Sep;42(3):274–278. [PMC free article] [PubMed]
  • Fearn R. Rural health care: a British success or a tale of unmet need? Soc Sci Med. 1987;24(3):263–274. [PubMed]
  • Grant JA. Contribution of general practitioner hospitals in Scotland. Br Med J (Clin Res Ed) 1984 May 5;288(6427):1366–1368. [PMC free article] [PubMed]
  • Blair JS, Grant J, McBride H, Martin A, Ross RT. Casualty and surgical services in Perthshire general practitioner hospitals 1954-84. J R Coll Gen Pract. 1986 Aug;36(289):359–362. [PMC free article] [PubMed]
  • Brakenbury PH, Jaya-Ratnam JS. Accident and emergency services--the contribution of the community hospital. Health Trends. 1985 May;17(2):31–32. [PubMed]
  • Tulloch AJ. 'Out of hours' calls in an Oxfordshire practice. Practitioner. 1984 Jul;228(1393):663–666. [PubMed]
  • Marsh GN, Channing DM. Comparison in use of health services between a deprived and an endowed community. Arch Dis Child. 1987 Apr;62(4):392–396. [PMC free article] [PubMed]
  • Morrison WG, Pennycook AG. A study of the content of general practitioners' referral letters to an accident and emergency department. Br J Clin Pract. 1991 Summer;45(2):95–96. [PubMed]
  • Main JA, Main PG. Twenty four hour care in inner cities. BMJ. 1989 Sep 2;299(6699):627–627. [PMC free article] [PubMed]
  • Carlisle RD, Johnstone SP, Pearson JC. Relation between night visit rates and deprivation measures in one general practice. BMJ. 1993 May 22;306(6889):1383–1385. [PMC free article] [PubMed]
  • Myers P. Management of minor medical problems and trauma: general practice or hospital? J R Soc Med. 1982 Nov;75(11):879–883. [PMC free article] [PubMed]
  • Reilly PM. Primary care and accident and emergency departments in an urban area. J R Coll Gen Pract. 1981 Apr;31(225):223–230. [PMC free article] [PubMed]
  • Cohen J. Accident and emergency services and general practice--conflict or cooperation? Fam Pract. 1987 Jun;4(2):81–83. [PubMed]
  • Singh S. Self referral to accident and emergency department: patients' perceptions. BMJ. 1988 Nov 5;297(6657):1179–1180. [PMC free article] [PubMed]
  • Calnan M. The functions of the hospital emergency department: a study of patient demand. J Emerg Med. 1984;2(1):57–63. [PubMed]
  • Nguyen-Van-Tam JS, Baker DM. General practice and accident and emergency department care: does the patient know best? BMJ. 1992 Jul 18;305(6846):157–158. [PMC free article] [PubMed]
  • Green J, Dale J, Glucksman E. Half the aggro. Health Serv J. 1991 Oct 24;101(5275):25–25. [PubMed]
  • Calnan M. The hospital accident and emergency department: what is its role? J Soc Policy. 1982 Oct;11(4):483–503. [PubMed]
  • Roth JA. Some contingencies of the moral evaluation and control of clientele: the case of the hospital emergency service. AJS. 1972 Mar;77(5):839–856. [PubMed]
  • Williams DJ. Patients' assessment of out of hours care. Br Med J (Clin Res Ed) 1988 Apr 23;296(6630):1197–1197. [PMC free article] [PubMed]
  • O'Dwyer F, Bodiwala GG. Unscheduled return visits by patients to the accident and emergency department. Arch Emerg Med. 1991 Sep;8(3):196–200. [PMC free article] [PubMed]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...