Impact of NHS Direct on demand for immediate care: observational study

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Abstract
Objectives: To quantify the impact of NHS Direct on the use of accident and emergency, ambulance, and general practitioner cooperative services. Design: Observational study of trends in use of NHS Direct and other immediate care services over 24 months spanning introduction of NHS Direct. Setting: Three areas in England in first wave of introduction of NHS Direct, and six nearby general practitioner cooperatives as controls. Subjects: All contacts with these immediate care services. Main outcome measures: Changes in trends in use after introduction of NHS Direct. Results: NHS Direct received about 68 500 calls from a population of 1.3 million in its first year of operation, of which 72% were out of hours and 22% about a child aged under 5 years. Changes in trends in use of accident and emergency departments and ambulance services after introduction of NHS Direct were small and non-significant. Changes in trends in use of general practitioner cooperatives were also small but significant, from an increase of 2.0% a month before introduction of NHS Direct to −0.8% afterwards (relative change −2.9% (95% confidence interval −4.2% to −1.5%)). This reduction in trend was significant both for calls handled by telephone advice alone and for those resulting in direct contact with a doctor. In contrast, the six control cooperatives showed no evidence of change in trend; an increase of 0.8% a month before NHS Direct and 0.9% after (relative change 0.1% (−0.9% to 1.1%)). Conclusion: In its first year NHS Direct did not reduce the pressure on NHS immediate care services, although it may have restrained increasing demand on one important part—general practitioners' out of hours services.