| Abstract
| - Abstract. Objectives: To undertake a district wide review of out of hours primary health care services and identify the views of users and providers about current arrangements and options for development. Design: A range of qualitative and quantitative survey methods based on rapid appraisal methods, modified to apply to an inner city district. Setting: Socially deprived, multiethnic district in south east London with a population of over 700 000. Main outcome measures: Strengths and weaknesses of current out of hours services and suggestions for developments. Results: Widespread dissatisfaction with current arrangements was identified, with specific problems relating to access, availability, demand for services, and interagency communication. Several areas for development were identified, including the establishment of an out of hours cooperative, multiagency primary care emergency centres, and telephone advice-triage. Many of these are now being planned or piloted. Conclusions: Rapid appraisal provided a helpful method, enabling partnerships to be established between local agencies and users in relation to service development. The shared understanding and commitment to improving services that resulted is now having a major impact on out of hours care in the district. Key messages. Considerable potential exists for improving the integration and communication between existing service providers Implementing new arrangements is likely to involve considerable change. Rapid appraisal provides a methodology for eliciting and interpreting the views of a broad range of local stakeholders and involving them in decision making about new services Many suggestions for service developments were suggested in this study, and many are now being piloted or implemented
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