Objectives: To quantify the impact of NHS Direct on the use of accident and emergency, ambulance, and general practitioner cooperative services.
Design: Observational study of trends in use of NHS Direct and other immediate care services over 24 months spanning introduction of NHS Direct.
Setting: Three areas in England in first wave of introduction of NHS Direct, and six nearby general practitioner cooperatives as controls.
Subjects: All contacts with these immediate care services.
Main outcome measures: Changes in trends in use after introduction of NHS Direct.
Results: NHS Direct received about 68 500 calls from a population of 1.3 million in its first year of operation, of which 72% were out of hours and 22% about a child aged under 5 years. Changes in trends in use of accident and emergency departments and ambulance services after introduction of NHS Direct were small and non-significant. Changes in trends in use of general practitioner cooperatives were also small but significant, from an increase of 2.0% a month before introduction of NHS Direct to -0.8% afterwards (relative change -2. 9% (95% confidence interval -4.2% to -1.5%)). This reduction in trend was significant both for calls handled by telephone advice alone and for those resulting in direct contact with a doctor. In contrast, the six control cooperatives showed no evidence of change in trend; an increase of 0.8% a month before NHS Direct and 0.9% after (relative change 0.1% (-0.9% to 1.1%)).
Conclusion: In its first year NHS Direct did not reduce the pressure on NHS immediate care services, although it may have restrained increasing demand on one important part-general practitioners' out of hours services.