Main Report of the National Review of Primary Care Out of Hours Services

14 Research and Evaluation

The Review commissioned a rapid systematic review of the international literature, and focus group research from the Scottish School of Primary Care and undertook separate survey work (Annex F) and in full on the Review website.

Recommendation 26 refers to research and evaluation

Evidence

During the course of the course of this systematic review yielding 274 research papers for scrutiny, a paucity of robust evaluation of models of OOH services was found.

Key areas identified as being crucial in the development of high quality OOH services

• Good communication and information technology, both across OOH service providers but also across the daytime and OOH interfaces.
• Better understanding of how patients view OOH services and the decisions they make in relation to which service they choose to attend.
• Development and evaluation of new professional roles in OOH care, in particular pharmacy, but also other organisations out with health care
• Better engagement with early career GPs, with trainees and with undergraduate medical students to promote the value and professionalism of providing out-of-hours care.
• Improvement in career development and training for other professional groups.
• Single, centralised systems have to be 'future proofed' to address the contextual realities of different areas, for example patients in remote and rural areas have different needs and capacity to respond compared to those in urban areas. This is also true in relation to socioeconomic deprivation.

Recommendations for research and evaluation

• Future models of care need to be rigorously evaluated using experimental research designs which will allow both clinical and cost effectiveness to be addressed. The methodology used should include cluster randomised controlled trials and alternative study designs, such as stepped-wedge study designs, to best inform the development of OOH delivery programmes. This research should pay particular attention to the requirements of key groups with specific needs, including palliative care, mental health, frail older people and individuals with communication and accessibility issues.
• Future evaluation designs should include economic evaluation to assess not only the immediate costs of new models of care, but also the wider impact on other parts of the health and social care system, in relation to health and social care integration imperatives.
• A better understanding is required of the decision-making of patients and carers in terms of: what they know and understand of different parts of the OOH system and what makes them choose one service provider over another (for example phoning NHS 24 versus attending A&E services).
• Co-location, co-working and integration of services should be underpinned and informed by evaluation, including qualitative process evaluation to understand the challenges and facilitating factors for co-location, co-working and integration.

Summary

The lack of relevant published literature and planned service evaluations in OOH services have significantly hampered understanding of best practice. Future research and development (R&D) support should inform and evaluate new models of OOH and urgent care services, including economic assessment (Annex F).

Scottish Fire and Rescue Service and First Responder Team, Maud