This study provides the first evidence in the UK about patient satisfaction and experiences of GP led walk-in centres. The GP walk-in centres operate with longer opening hours than routine GP surgeries and open during weekends and bank holidays, have a GP at the centre along with nurse practitioners, and are able to retrieve patients’ records to update any treatment or advice given at the centre
. The location and opening hours of these centres are highly satisfactory for the majority of the patients. Convenience of centre A was reported as slightly higher, possibly because of the availability of free onsite car parking for patients. Studies have shown that patients use walk-in facilities because of easy access and much shorter waiting times as compared to GP practices
. Unregistered patients were in higher proportion at centre B, possibly because of the higher number of students living in the location. We found no major difference in satisfaction levels with this service between registered and unregistered patients.
Our study has sought to understand more about community needs and satisfaction with walk-in facilities. This is important because some of these centres have been closed because of lack of evidence of having any beneficial effects for the NHS
. Studies have shown that patients prefer to see a GP for unscheduled care instead of using other parallel services
. A large proportion of patients presented to the GP led walk-in centre because they were unable to reach their own GP (either the GP surgery was closed or the patient’s working hours did not allow them to see a GP) and in some cases they were not registered with any GP at all. In these circumstances, the patients would either present at ED, wait for their own GP, or may have just ignored their health problem, which could possibly have led to presenting at ED at a later time. Some GP led centres are now co-located with traditional nurse led walk-in centres. Studies have shown high patient satisfaction with nurse led walk-in centres in the past
[3, 16]. Thus, the model of combining two services, a nurse led walk-in centre and a GP centre, could be more effective than completely replacing one service with another.
We found that a high proportion of patients attending the two centres we have studied were very satisfied overall with the services. This was true for both first time users and repeat users and so is not just a type of ‘survivor’ effect due to dissatisfied patients subsequently using alternative services such as minor injuries units or ED. The satisfaction scale was dichotomised into “Highly satisfied” (score = 5) and “Not highly satisfied” (scoring 1–4) which is recommended as the most appropriate cut off for understanding patients’ satisfaction
. The longer time to be seen at one centre, particularly during evenings and weekends, was of concern. This also affected patients’ satisfaction with the service. The results reported in Table
5 show that the odds of reporting to be “highly satisfied” with the service reduce by around 2% with every minute increase in the waiting for treatment. After controlling for the effect of the waiting time there was no difference in the satisfaction level between the two centres. Studies show that waiting time is one of the important factors for evaluating emergency care services as it has significant impact on the quality of care and patients’ outcome
[18, 19]. Another study has reported that waiting time is a very important determinant of satisfaction in primary care out-of-hours services
. Patients seen by both a nurse and a GP had longer waiting times than those seen by one health care professional only. It was also observed in the analysis that the mean satisfaction score was significantly higher for those seen by one health care professional in comparison with two or more (Mean = 4.43, SD = 0.83 versus Mean = 4.22, SD = 1.02; P value = 0.02). In addition, the proportion of “Highly Satisfied” were also higher in those who were seen by one health care professional (58%) in comparison with two or more (49%) [Chi2 = 3.5; P value = 0.06]. However, after controlling for waiting time, there was no significant difference between the two groups. Centre B had a significantly higher proportion of patients seen by two health care professionals. The triage system at the two centres works differently, which might be responsible for the difference.
Previous studies have shown higher satisfaction rates with nurse led walk-in centres (79% reporting being highly satisfied) compared to the GP led walk-in centres we have studied (49% and 64%), though our results are comparable with reported patient satisfaction with GP practices (66%)
. The patient satisfaction levels we observed were also generally lower than those reported for nurse led commuter walk-in centres in London and outside London which ranged from 51% to 79%
Our results show that most of the patients had very high compliance with the treatment/advice given at the centre and a large proportion of patients reported that their problem was fully resolved after visiting the centre. This suggests that the centres are important in fulfilling local community needs particularly at times when other services are not accessible. Our data also shows that the activity of these centres is higher at evening and weekends than during office hours, and this is one of the signs of increasing patients’ accessibility to GPs at times when their own GP is not available. However, it was also observed that a high proportion of patients visit their GPs soon after visiting the walk-in centre which suggests there is a risk of potentially duplicating the existing services. Though it would still be a useful service if patients would have otherwise gone to ED in times when their own GP was not opened. It was asked in the questionnaire that what patient would have done if the GP walk-in centre had not been established, which showed that around 23% of patients would have gone to ED; the proportion was higher (27%) for those who attended the service during evenings or weekends than those who attended during office hours (15%).
There are a number of important limitations to this study. First, we have only looked at two centres in the UK. We believe that the services offered by these two models are typical of others across the NHS, but it is possible that their locations and patient populations are not. Most of the other GP walk-in centre services in the UK would be similar to one model or the other or lie somewhere between these two models. The core purpose of the GP walk-in centres is identical all over the UK, which is to offer GP access without appointment and available over weekends and evenings. Therefore, the findings of this study can be used to understand satisfaction and experiences with GP walk-in centre in the UK. Walk-in Centres have been established in the United States, Canada
 and also introduced recently in Australia
. In countries where services have just started or are being planned, it is very useful to refer to experiences with similar services in other countries. Thus, it is important to understand how these kinds of services work, what kind of patients attend these services and how effective they are in addressing patient needs. We believe the findings of this paper can be extrapolated to other similar settings where GP access needs to be improved.
Second, the response rate to our patient survey was only 57%, and the response rate to our follow-up post visit survey only 50% of those who received the questionnaire. Furthermore only around one third of the patients attending these services during the survey period received the questionnaire (an estimated 1821 out of 5899). In many surveys, the response rate is a major source of bias
. There were a number of reasons why the questionnaire was not received by every patient attending the service. Firstly, the survey questionnaire was handed out by the receptionists, so during some very busy hours it was not always possible to hand over the questionnaire to every single patient due to the time required to describe the study. Secondly, the questionnaire was given to the patients along with the patient registration sheet which every patient receives when they present to a walk-in centre. If the patient returned their completed registration sheet along with a non-completed questionnaire, the receptionists sometimes redistributed the questionnaire to the next patient. In this case it was not possible to keep a record of how many patients actually received the questionnaire. In addition, survey questionnaires were also placed in the waiting area to be accessible for every patient. Therefore, our estimates of the numbers receiving the questionnaire are based on the number of questionnaires known to have been distributed and the number of filled-in questionnaires returned to us. However, the number of patients who actually received a questionnaire may be larger than this. Studies have reported that patients’ satisfaction systematically differ between patients with different characteristics including age, sex and ethnicity
[9, 23]. However, the comparison of the demographics of our survey respondents with routine centre data did not show any significant difference between the two populations, so we expect that the sample is a true representation of the population.
Another limitation was the lack of recording the perceived health status of the patients in the survey. It has been reported that perceived health status is an important determinant of patient satisfaction
[10, 24]. Therefore, it could have been incorporated to help explain differences in satisfaction levels for example between centres or age groups. Lastly, the questionnaire was not re-validated for the purposes of this study, although the satisfaction scale used in the study was exactly the same as used in previous studies (3,12). It is possible that some of the dimensions of satisfaction with these services are missing in this scale. However, in this paper the analysis was based on “overall satisfaction” which includes all dimensions of satisfaction. There is a systematic review which has questioned the reliability and validity of questionnaires used to measure satisfaction with out-of-hours health care services
. The review found that most of the published satisfaction questionnaires are not fully validated to measure satisfaction and need to be used with caution. The review, however, suggested that it is preferable to use published scales rather than those which have not been published. Thus, the use of the same satisfaction scale in this study which has been used in similar health care settings by other studies enabled us to make comparisons with other satisfaction studies.