• J Foster, J Dale, and L Jessopp.
• Guy's, King's and St Thomas' School of Medicine, Division of Primary Care and Public Health Sciences, Department of General Practice and Primary Care, Weston Education Centre, 10 Cutcombe Road, London SE5 9PJ. judy.foster@kcl.ac.uk
• Br J Gen Pract. 2001 Sep 1;51(470):719-23.

BackgroundOut-of-hours primary care services continues to change with the growth of general practitioner (GP) co-operatives and the more recent development of NHS Direct. While older people are more likely to have increased needs for such services, evidence suggests that they are reluctant users of GP out-of-hours services.AimTo explore older people's experiences and perceptions of different models of general practice out-of-hours services.Design Of StudyFocus group methodology, with qualitative data analysis undertaken using a grounded theory (Framework) approach.SettingThirty people aged between 65 and 81 years old from community groups based in south east London.MethodFour focus groups were held, each with between five and 12 participants. Each focus group session lasted 90 minutes and was audiotape-recorded with the permission of the participants. The tapes were transcribed verbatim.ResultsTwo related themes were identified. First, attitudes to health and healthcare professionals with reference to the use of health services prior to the establishment of the NHS, a stoical attitude towards health, and not wanting to make excessive demands on health services. Second, the experience of out-of-hours care and the perceived barriers to its use, including the use of the telephone and travelling at night. Participants preferred contact with a familiar doctor and were distrustful of telephone advice, particularly from nurses.ConclusionsOlder people appear reluctant to make use of out-of-hours services and are critical of the trend away from out-of-hours care being delivered by a familiar GP. With increasing numbers of older people in the population it is important to consider steps to address their reluctance to use out-of-hours and telephone advice services, particularly those based around less personal models of care.

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