This major study charts the evolution of one of the largest UK providers of telephone-based access to primary care - the NHS Direct call centre in West London.  This centre serves a catchment population of about 1.35m, handles a quarter of a million calls annually and was the first to combine NHS Direct with an existing GP out-of-hours co-operative (HARMONI), which already used the pilot computerised software (TAS).  This study was commissioned to answer the question:  "Has NHS Direct increased the workload of GPs?"  It sets out to track trends in GP workloads, changes in the pattern of referrrals, the evolution of working practices, and the transformation of relationships between doctors, triage nurses and call handlers at West London.  It also includes a detailed evaluation of the role of computerised patient call records in management decision making.  The study used both longitudinal and cross-sectional analysis, involving over 25,000 anonymised patient computer records spread over three annual study periods (1998, 1999 and 2000), and some two dozen in-depth interviews with key personnel.  With over 100 tables and graphs (many in colour), this volume provides detailed evidence of the way in which a major NHS Direct site has developed and what the impact has been.  For example, the quantitative data indicate significant changes in referring behaviour, while the qualitative data show a change in the triage nurses' role from gatekeeper to patient advocate.  This study will be of interest to all those concerned with the provision of seamless primary care, the impact of the government's modernisation programme, and current trends in nurse-based telephone triage.  Its findings are applicable to the future development of NHS Direct and its relationship with GP out-of-hours care.  For further information on how to obtain a copy telephone +44 (0)20 8411  5857 or email A.Mark@mdx.ac.uk.  It can also be purchased from the Kings Fund Book Shop.
