What is the role of walk-in centres in the NHS?

In April 1999 the Department of Health authorised funding for a pilot scheme of 40 NHS walk-in centres in 30 towns and cities across England, the first of which opened in January 2000. The overall aim of walk-in centres is to improve access to high quality health care in a manner that is both efficient and supportive of other local NHS providers. It is hoped that the centres will complement other primary care initiatives such as NHS Direct, playing a major part in the government’s commitment to modernise the NHS. Key features of NHS walk-in centres are shown in the box. The establishment of walk-in centres within the NHS has been controversial. The claimed advantages are that centres improve access to health care through wide opening hours, a convenient location, and minimal waiting without an appointment. By using software for clinical assessment, nurses should be able to provide high quality care for patients, reducing demand on other NHS services and maximising efficiency. Such centres may also increase the appropriateness of patients’ problems seen by other NHS providers by encouraging self care and helping people to identify when they need to consult a doctor. Critics have put forward several counter-arguments. Walk-in centres may increase access primarily for affluent people, thus increasing health inequalities. Increased accessibility may increase total demand on the NHS, with little health gain being seen if patients primarily consult with self limiting illnesses. Diverting patients to walk-in centres is efficient only if centres provide care more cheaply than other providers, and achieving a “no wait” service may need a high level of staffing with high costs per consultation. Nurses may be no less expensive than doctors if they spend longer on consultations, and it is not certain that nurses can safely manage the wide range of problems seen in primary care. Finally, walk-in centres could undermine continuity of care, leading to duplication (people consulting different agencies about the same problem) and inappropriate care (due to lack of records about medical history). Although walk-in centres have existed in other countries for many years, little research has been done on their impact, and the evidence that does exist from other healthcare systems may have little relevance to the NHS. The Department of Health has commissioned a comprehensive independent evaluation of NHS walk-in centres, which uses both quantitative and qualitative methods to describe the process and outcomes of care, including studies of the efficiency of walk-in centres and their impact on other NHS providers. Key features of NHS walk-in centres