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 nonsignificant. 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
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