Comparison of out of hours care provided by patients' own general practitioners and commercial deputising services: a randomised controlled trial. II: the outcome of care

Abstract

Objective: To compare the outcome of out of hours care given by general practitioners from patients' own practices and by commercial deputising services. Design: Randomised controlled trial. Setting: Four urban areas in Manchester, Salford, Stockport, and Leicester. Subjects: 2152 patients who requested out of hours care, and 49 practice doctors and 183 deputising doctors (61% local principals in general practice) who responded to the requests. Main outcome measures: Health status outcome, patient satisfaction, and subsequent health service use. Results: Patients seen by deputising doctors were less satisfied with the care they received. The mean overall satisfaction score for practice doctors was 70.7 (95% confidence interval 68.1 to 73.2) and for deputising doctors 61.8 (59.9 to 63.7). The greatest difference in satisfaction was with the delay in visiting. There were no differences in the change in health or overall health status measured 24 to 120 hours after the out of hours call or subsequent use of the health service in the two groups. Conclusions: Patients are more satisfied with the out of hours care provided by practice doctors than that provided by deputising doctors. Organisation of doctors into large groups may produce lower levels of patient satisfaction, especially when associated with increased delays in the time taken to visit. There seem to be no appreciable differences in health outcome between the two types of service. Between 24 and 120 hours after a request for out of hours care patients cared for by deputising services and practice doctors show no difference in health status There is no difference in health service use between the two groups in the two weeks after a request for out of hours care Patients are more satisfied with out of hours care provided by their own practice doctors Though patients are more satisfied with out of hours care provided by practice doctors, their health outcomes are no better than when care is provided by a deputising service