Richard Craven on extending out-of-hours services

Lord Darzi's call for extended access to family doctors and for money to be allocated to primary care trusts to set up GP-led walk-in centres could pave the way for expanding patients' access to care.

This has caused a stir with GPs, with three-quarters of them saying this would not be a good use of NHS resources, according to the results of a British Medical Association survey released in October. However, the recommendations send out a positive message to patients - efforts are being made to extend access to services.

Private organisations are lining up to provide the additional facilities. More services in pharmacies are on the cards, with privately run walk-in centres to be operated in collaboration with PCTs; Virgin has plans to set up two or three urban health centres; and a development at Preston North End football club will include a health centre on site.

Choice overload

Clearly, the NHS and private businesses are looking at new ways to open up healthcare services to the population, but in my view there may be insufficient direction for patients on how to use these services.

GP surgeries, accident and emergency, walk-in centres, minor injury units, urgent care centres - how do we know where to go? And where do we go to find out?

What is needed is a unified way to access healthcare, a process whereby the patient knows where to go for the right level of care, at the right time, and for the best possible outcome.

Healthcare services also need to form an identity - to recognise their specific role in their sector and region. And from a national perspective, a clearer definition of each facility can only aid the planning and budgeting process.

Clearing things up

A telephone or web-based service would fit the bill. The success of the NHS Direct model, which has now been replicated in countries including Portugal and Australia, shows how this kind of service can operate successfully and be developed to provide more than simply triage. In addition to reacting to calls from the public, the service provides outbound calls to those with long-term conditions and advice in the case of a national emergency.

Whether the current infrastructure and personnel would be best placed to carry out a unifying function is questionable, but the UK's experience of a national health help-line and website has shown that people are ready and willing to embrace further telehealth services.

So while we wait for clinics and treatment centres to pop up in unusual and innovative locations, providing more and more of us with 24-hour access to care, shouldn't we be thinking about where we are going and how we might get there?

Without better direction for patients, we could lose sight of the aim of this initiative - to increase efficiencies and improve patient care.