Study of walk-in centres was flawed

British Medical Journal, April 14, 2001 by Steve George, Val Lattimer

EDITOR--Jones in her news item reported a study that the Consumers' Association had conducted on NHS walk-in centres.[1] The title of the report implies conclusive results. Jones does not, however, mention the methodological flaws of the study, and there are many.

This was a small study, designed and presented in a similar fashion to that on NHS Direct, published in August last year, which attracted criticism.[2] Once again no control group was used, so we have no idea whether these "patients" would have fared any better if they had seen their own general practitioners or a general practitioner's deputising service or attended an accident and emergency department. Much is made in the paper about how patients were quizzed openly by reception staff at walk-in centres, and that "Bob," the potential emergency patient, did not get past reception in five centres, although he needed a proper consultation. Bob reportedly attended the centres asking for a repeat prescription for a glyceryl trinitrate spray for his angina. Is this indicative to a receptionist that he needed a proper consultation? We suspect that, had he gone to his own general practitioner and asked reception staff for a repeat prescription, he would have got one, probably a day or two later, but that he would not have received a consultation with a general practitioner unless he had asked for one. We do not know what he asked for at any of the walk in centres visited as no details of the script--if one was used--were included.

This is not the only flaw in the article. We are told that scenarios were judged by a panel of experts, but we were not told of any instances in which they disagreed or had to reach a consensus. We do not believe that the panel agreed totally on each and every point mentioned in this paper. Altogether the weaknesses of the study make it unlikely that it would have been published in a peer reviewed journal. The business of the Consumers' Association is selling magazines to the public, and a certain amount of journalistic licence is to be expected. Whatever one's personal views on walk-in centres, however, the results of a properly designed evaluation such as that commissioned by the Department of Health should be awaited before passing judgment.

[1] Jones J. NHS walk-in centres fail to assess patients. properly. BMJ 2001;322:70. (13 January.)

[2] Mayor S. Health watchdog criticises NHS helpline. BMJ 2000;321:401. (12 August.)

Steve George reader in public health

Val Lattimer reader in nursing University of Southampton, Health Care Research Unit, Southampton General Hospital, Southampton SO16 6YD pluto@soton.ac.uk