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Research project: Evaluation of the Out-of-Hours Exemplar Programme - Dormant - Dormant

Currently Active: 

The Report of the Independent Review of GP Out-of-Hours services "Raising Standards for Patients: New Partnerships in Out-of-Hours Care" (Department of Health, 2000) recommended an integrated approach to service provision in which patients would experience fast, fair and convenient access to care of a consistently high standard in response to urgent health needs out-of-hours.


Two principles were determined to be central to the new approach. First, patient access to out-of-hours care would be as simple and straightforward as possible - one telephone call, providing effective and timely advice and, where necessary, a face-to-face consultation at a time and place agreed with the patient. Second, all professionals involved in the delivery of care out-of-hours would work together to deliver the best possible service to patients and to make the most effective use of resources

Main question(s)

The proposal which will assess the impact of the integrated model on service responsiveness and integrity, and on the extent to which the quality standards set out in the Review are being met. As in the Review report itself, the starting point for the evaluation has been the patient perspective.

The study will address the following research questions:

In comparison with usual care:

  • How prompt and accessible is care for patients who contact an integrated service?
  • How rapid and effective is the flow of patient level information within the integrated network, and how sufficient, contemporary and pertinent is that information?
  • What is the evidence that patients are transferred, referred or transported to a wider range of organisations and services?
  • What impact does integration have on activity within other immediate care services, and on the rate of emergency hospital admission?
  • What do consumers expect from out-of-hours care, what preferences do they express for different service attributes, and in what ways are they satisfied or dissatisfied with care they receive?
  • What organisational characteristics and processes are associated with sustained progress towards meeting the quality standards demanded for integration, with particular reference to local partnerships, operational management and characteristics of the local health economy.
  • What are the economic issues for the NHS of the fully integrated model of out-of-hours provision, and what costs are associated with different levels of integration?


The project has three components: an observational study of all exemplars; a controlled before and after comparison of three exemplar sites with six matched control sites and detailed case studies of the these exemplars. Methods of data collection include prospective and retrospective data on case mix, patterns of demand, activity and referral; non-participant observation; interviews with key stakeholders; documentary analysis; telephone survey of callers; community surveys using discrete choice method (conjoint analysis).

Main outcomes

Outcomes include analysis of policy implementation and benchmarking of progress toward national standards; in depth descriptions of case studies and the benefits of partnership working and an assessment of the impact of integration on the wider health and social care economies.


Department of Health (2000) Raising Standards for Patients: New Partnerships in Out-of-Hours Care. An Independent Review of GP Out-of-Hours Services in England . London : Department f Health. Department of Health (2000) Department of Health response to the Independent Review of GP Out-of-Hours Services in England Report. London : Department of Health. Department of Health (2001) Implementing the OOOH Review: Raising Standards for Patients. New Partnerships in Out-of-Hours Care. The"Exemplar" Programme . London : Department of Health.
Morgan A, Shackley P, Pickin M, Brazier J. (2000) Quantifying patient preferences for out-of-hours primary care. Journal of Health Services Research and Policy 5:214-8.
Scott A, Watson MS, Ross S. Eliciting preferences of the community for out of hours care provided by General Practitioners: a discrete choice experiment. Social Science and Medicine (forthcoming) . 

Project team

Karen Gerard, Val Lattimer

Project funder

Department of Health

Related research groups

Health Work and Systems
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