Williams B T, Dixon R A, Nicholl J P
Br Med J (Clin Res Ed). 1985 Dec 14;291(6510):1689-92. doi: 10.1136/bmj.291.6510.1689.
In a typical two week period in 1984 in three urban areas with general practitioner deputising services roughly 40% of first contact patient encounters out of hours were with hospital accident and emergency departments, and only a quarter were with general practitioner deputising services, although 47%, 64%, and 97% of general practitioners in the areas had permission to use such services. Roughly a third only of the encounters were with the practices themselves, and even fewer occurred overnight (11 pm-7 am). In a fourth urban area where 68% of general practitioners formed an out of hours cooperative rota a third of the encounters were with the accident and emergency department and half (more overnight) were with the rota. The presence of a woman principal in a practice and large partnerships of four principals or more were associated with an increased proportion of encounters with the practice itself. Undue prominence may have been given to the role of deputising services in out of hours care. Paradoxically, the use of general practitioner cooperatives may result in even less personal care being given by the patient's own practice.
1984年，在三个设有全科医生代理服务的城市地区，在典型的两周时间里，约40%的非工作时间首次接触患者的诊疗是在医院急诊科进行的，只有四分之一是与全科医生代理服务机构进行的，尽管这些地区47%、64%和97%的全科医生有权使用此类服务。大约只有三分之一的诊疗是在诊所本身进行的，夜间（晚上11点至早上7点）发生的诊疗更少。在第四个城市地区，68%的全科医生组成了非工作时间合作轮值小组，三分之一的诊疗是在急诊科进行的，一半（夜间更多）是与轮值小组进行的。诊所中有女性负责人以及四个或更多负责人组成的大型合伙诊所，与在诊所本身进行诊疗的比例增加有关。在非工作时间护理中，代理服务的作用可能被过度强调了。矛盾的是，使用全科医生合作社可能会导致患者自己的诊所提供的个性化护理更少。
