Impact of NHS walk-in centres on primary care access times: ecological study

Abstract

Objective: To examine whether walk-in centres contribute to shorter waiting times for a general practice appointment.

Design: Ecological study.

Setting: 2509 general practices in 56 primary care trusts in England; 32 walk-in centres within 3 km of one of these practices.

Main outcome measure: Waiting time to next available general practitioner appointment (April 2003 to December 2004), from national monthly primary care access survey.

Results: The percentage of practices achieving the target waiting time of less than 48 hours to see a general practitioner increased from 67% to 87% over the 21 month study period (adjusted odds ratio 1.07 (95% confidence interval 1.06 to 1.08) per increase in month). Achievement of the waiting time target decreased with increasing multiple deprivation (0.57 (0.49 to 0.67) for most versus least deprived third) and increased with increasing practice population size (1.02 (1.00 to 1.04) per 1000 increase). No evidence was found that increasing distance from a walk-in centre was associated with decreasing odds of achieving the waiting time target (1.00 (0.99 to 1.01) per km increase). Increasing "exposure" to a walk-in centre, modelled with a distance decay function based on attendance rates, also showed little evidence of association with achievement of the waiting time target (1.02 (0.97 to 1.08) for interquartile range increase). No evidence existed that the rate of increase in achieving the 48 hour target over time was enhanced by proximity or "exposure" to a walk-in centre. Results were similar when the analysis was rerun with data for 2003 only (done because pressure in 2004 to meet the government's deadline might have led to other changes that could have masked any walk-in centre effect).

Conclusions: No evidence existed that walk-in centres shortened waiting times for access to primary care, and the results do not support the use of walk-in centres for this purpose.

Fig 1 Walk-in centre attendance rates by distance from walk-in centre based on data on people attending four established walk-in centres in England, 2003-4

Fig 2 Relative frequency distribution of waiting time (days) to the next available general practitioner appointment at 2509 general practices in the study areas in England, April 2003 to December 2004