The results of this study show that at the end of 2005 there was great variety in the way out-of-hours emergency services were organized in Norway. We received completed questionnaires from all of the country’s municipalities, but the percentage of replies to individual questions varied greatly. The reason for this may be that certain replies were only recorded to a limited degree at a local level. In spite of this, we believe the survey has covered most of the relevant points concerning the organization of out-of-hours service in Norway.
Most municipalities were already participating in intermunicipal cooperations and this was clearly most common in the smaller ones. It has been argued that such cooperation improves the service in terms of staffing, equipment and security and has a positive effect on recruitment, as well as easing the duty load (9). Work is being done to bring more municipalities into such cooperation, although this was already occurring to a greater degree than realized beforehand (6, 10). There are many small intermunicipal co-operations, some of which could be expanded. Others will be able to function well alone because of their size, or may have problems cooperating due to geographical considerations.
Our study has shown that in half of the country’s municipalities all RGPs participate in out-of-hours emergency service. Non-participation may be due to disease or age. The highest percentage of RGP participation was found in the smallest municipalities (fewest inhabitants). The reason for this may be that doctors in small districts feel that out-of-hours emergency service is a natural part of general practice and that exemption for one doctor leads to an extra heavy workload for the others. Some head doctors answered in addition that there has been a marked drop in the number of RGPs participating in out-of-hours service, and that those who do participate do so to an ever-decreasing degree. It is possible that in some cases it was not known who actually took the duties, i.e. whether the RGP was really the doctor on call even if the name was on the duty list. RGPs’ participation in out-of-hours emergency duty should be studied more closely and followed up over time. The National Centre for Emergency Primary Health Care is particularly interested in this area.
It is disturbing that only a minority of municipal out-of-hours services documented the number of telephone requests received. Moreover, documentation on daytime contacts was often missing, as the RGP surgery mainly dealt with these. It is less than satisfactory that such a comprehensive and important service as emergency primary health care should almost entirely lack a national statistical basis for vital variables such as the number of telephone requests from patients, consultations, diagnoses and finances.
1/5 of the local authorities did not document all telephone requests to the LEMC. This was particularly the case in the smaller municipalities. This may be explained by less established office routines due to fewer telephone requests and/or running the emergency call centre alongside other work, e.g. in a nursing home. There is still a long way to go before all the call centres have telephone recording of incoming phone calls.
Ambulances could not reach all inhabitants within half an hour in half of the country’s municipalities. This is probably due to scattered housing in many Norwegian municipalities, with inhabitants living far out from the centre. We requested exact data for the longest travel time in the local district, which implied that we did not receive information about the population with a shorter transport time. According to the instructions for acute medical readiness in emergency situations, an ambulance should reach 90 % of the population in a sparsely populated area within 25 minutes (11). On the other hand, this guideline is understood to be independent of the district’s population density.
This study has given an overview of the organization and staffing of emergency operator telephone exchanges and out-of-hours services, accessibility of transport and RGPs’ participation. Uncertainty connected to the number of telephone requests indicates a need for additional studies and improvement of the whole service. It will be interesting to follow the development of many of the recorded variables over time.