How has NHS Direct changed primary care provision.

We studied a general practice cooperative in west London that served 900,000 patients. The telephone triage service subsequently became a pilot for the national service, NHS Direct. Both quantitative and qualitative data were used for the study. The quantitative data consisted of the (anonymized) patient computer records available on the telephone triage service for the first two weeks in December 1998, December 1999 and December 2000. Two significant events were identified. The first, which emerged principally from analysis of the quantitative call data, were changes in patient outcomes during the period that spanned the arrival of NHS Direct. The second, revealed mainly through analysis of the qualitative data, were changes in the behaviour, perceptions and work experience of the triage nurses. Significant behavioural and attitudinal transitions occur when primary care organizations are modifie