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NHS Direct has struggled to integrate with GP-led out-of-hours services and has triggered an increase in demand for ambulances, Government-commissioned research concludes.

An evaluation of four pilot regions testing integration between NHS Direct and existing out-of-hours providers found NHS Direct nurses did not deal with as many calls as nurses at GP co-operatives.

NHS Direct call centres were also found to be too remote from local providers, leading to longer response times.

Academics at the University of Southampton concluded the Government would have been better investing in local triage services for out-of- hours calls rather than spending millions on the national NHS Direct system.

Research presented at the annual Society for Social Medicine meeting last week found that in two of the four areas there were 'substantial difficulties' integrating NHS Direct with GP co-ops.

NHS Direct nurses in the best-performing pilot areas were also only able to deal with 30 per cent of out-of-hours calls, compared with 39 per cent achieved by GP co-operative nurses.

None of the other three case study sites achieved the 30 per cent level, and one dealt successfully with only 17 per cent of calls.

Calls to ambulance services rose in three of the four areas.

Study author Dr Steve George, director of the public health sciences and medical statistics unit at the University of Southampton school of medicine, said he believed the Government had been wrong to push NHS Direct as the

only option for out-of-hours triage.

'It's my view that we might be better served by a parallel processing system.

'You can have a system where populations of 100,000 are each served by a telephone triage system at a much more local level.'

Dr Prasad Rao, vice-chair of the National Association of GP Co-operatives and a GP in Stoke, said the strength of co-ops lay in their local knowledge: 'Being local is much more responsive and response times are therefore better.'

A spokeswoman for NHS Direct said its service standards had improved since the study was conducted.

By Nerys Hairon and Daile Pepper

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