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GPs less likely to see patients who live far from co-op centre

GPs working out-of-hours are less likely to see patients face-to-face if they live far away from the primary care centre, research reveals.

The decision to make a home visit or see a patient at the centre was inversely related to the distance to the patient's home, according to the analysis of 31,000 calls to a GP co-operative in the North-West.

The findings led the researchers to question whether GPs are being influenced by factors 'not entirely related to clinical care' when they negotiate with patients over whether to conduct out-of-hours consultations by phone or face-to-face.

But research leader Dr James Munro said it was impossible to tell where 'fault' lies.

'We can't say it's all down to doctors not wanting to

travel,' said Dr Munro, clinical senior lecturer at the University of Sheffield's medical care research unit. 'It may not be the doctor's fault and could be the patient's, but negotiation and the ultimate decision is clearly influenced by distance.

'There may have been some people who should have been seen, and some may get seen when they don't need to be.'

The study found 57 per cent of callers to the co-op were offered face-to-face consultations, of which a quarter were home visits.

But patients who lived 8-10 km from the primary care centre were 22 per cent less likely to be seen face-to-face than those living within 2km.

Those living more than 16km away were 62 per cent less likely to be seen.

Patients living in the most deprived areas were also 19 per cent less likely to be seen than those in the least deprived areas, according to results published in the Journal of Epidemiology and Community Health (September).

Dr David Lloyd, executive director of west London GP co-operative Harmoni, said: 'It's not doctors or nurses making the decision not to travel.

'It's a not uncommon ending to a telephone consultation ­ where in the doctor's clinical judgment the patient needs to be seen and has told them the most appropriate setting is the primary care centre, and they say they are not


Dr Munro, who is conducting the Government's official evaluation of NHS Direct, warned that the new contract could worsen the problem as out-of-hours boundaries extend to cover whole PCOs.

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