Effectiveness of a policy to reduce non-urgent night-time consultations in out-of-hours services

Abstract Background The utilization of Out-of-Hours General Practice (OOH-GP) services in the Netherlands has been increasing steadily. This has placed significant pressure on triagists and GPs to provide accessible and high-quality care, particularly because of patients with low-urgency health problems, who can wait to visit their GP during regular working hours. To alleviate the strain on OOH services during the night, the “spoed=spoed” policy has been implemented. This policy stipulates that only patients with urgent health problems can consult with a GP during the night (11 p.m. to 8 a.m.). However, it remains unclear whether this policy has effectively reduced consultations during the night. Methods For this study, we used pseudonymised data from electronic health records of 2/3 of Dutch OOH services (catchment area of 12.3 million), from Nivel Primary Care Database, from 2020-2023. We analysed the effects of the policy on contact rates and proportion of high-urgency health problems, by comparing OOH services that did and did not implement the policy, by comparing 6 months before and after implementation and by analysing variances across OOH services. Results Overall, there were no differences in the number or proportion of high-urgency consultations across OOH services that did and did not implement spoed=spoed. In those that did, there were no differences before and after implementation. However, certain OOH services exhibited a decrease in consultation, while also showing a higher proportion high-urgency health problems. Conclusions There is currently no definitive evidence regarding the effectiveness of “spoed=spoed”. However we should learn from the varied effects and experiences in different OOH-services, to facilitate further implementation or adaptation of the policy. Key messages • OOH services can and should learn from each other on what solutions are implemented to lower the care-burden during the night. • Policies aimed at reducing the utilization of OOH serviced should consider the conaxt from the patient, health care provider and organization.