The provision of 'same-day' care in general practice: an observational study

Background. Surveys suggest that general practice is perceived to be inaccessible, with long delays before it is possible to be seen by a doctor. Although there is demand for rapid access to care, this has the potential to decrease continuity of care, which research consistently shows to be valued by patients but stressful for doctors. Objective. Our aim was to investigate the provision of 'same-day' care and the characteristics, treatment expectations and priorities of patients attending for 'routine' and 'same-day' appointments. Methods. The uptake of same-day and routine appointments was determined from appointment system records. A self-completed questionnaire survey of people attending 362 same-day and 362 routine appointments at 15 general practices in Avon and Gloucestershire enabled comparisons with respect of patient characteristics and consultation experiences, patients' preferences for rapid access, seeing a known practitioner or seeing a doctor rather than a nurse. Results. The uptake per 1000 practice population per day was 7.6 [95% confidence interval (Cl) 7.1-8.1] for routine appointments and 3.8 (95% Cl 3.5-4.2) for same-day appointments. In univariable analyses, use of same-day care was greater by people who were younger, non-white, in work and with educational qualifications. They had attended the practice less often, waited less time to see a doctor previously, had their current problem for a shorter time and were more likely to expect a prescription. From multivariable analyses, only age, speed of previously obtaining appointments, expecting a prescription and having the problem for a short time were independently associated with receiving same-day care. Rapid access to care was rated as more important than seeing a known doctor for two clinical scenarios. Conclusions. Much care is provided currently on the day it is requested in general practice. The use of same-day care was related to acute illness and expectations but was not associated with deprivation or patient characteristics apart from age.