Reporting on primary care out-of-hours care: Is the news good or bad?

Problem

Primary care out-of-hours services (OOHS) in UK have changed dramatically over the last 15-20 years. Increasing and, supposedly, inappropriate use of primary care out-of-hours services (OOHS) is a concern to service providers. Public perception of OOHS might affect how people use services. One particular influence is print news, which frequently reports OOHS issues and related personal narratives. We explored how OOHS are portrayed in newspapers, with attention to the content and tone of reporting. Our research questions were:1) What is the overall article tone and does this vary by publication?2) Which case studies are mentioned and how are they portrayed?

Approach

Search strategy: LexisNexis database was used to identify newspaper articles from 01/01/2004-31/10/2015 containing terms “out-of-hours” [≥3 mentions] OR (“NHS24” OR “NHS111” OR “NHSDirect”) AND “out-of-hours” [≥1 mentions] in 10 major UK newspapers. Exclusions: Letters; duplicates; articles without a substantial portion concerning OOHS. We selected articles from years 2005, 2010 and 2015 for detailed content analysis.Content analysis: three researchers read the first 100 articles to independently identify themes and develop a coding framework. All articles from the selected years were then fully coded. Coding themes included: tone, OOHS-theme, negative headline-terms, personal narratives, expert citations, use of statistical evidence, GP opt-out from OOHS, confusion around services, staff shortages and unsafe staff.

Findings

Number of articles: 1625 total; 519 from selected years; 332 articles remaining after exclusions. 75.9% of articles were negative in tone while 21% were neutral and only 3.3% were positive. Article tone differed significantly by publication (positive tone p=0.001, neutral tone p=0.004) and all publications leaned significantly toward negative tone (p<0.01). 46.1% of articles mention a personal narrative of which 86% were portrayed as a tragedy. Reasons portrayed in personal narratives included: misdiagnosis over the phone, poor access to OOHS and unsafe staff. 77.8% of articles mentioning a personal narrative involved rare medical diagnoses. There was almost no information to inform the public about accessing services. OOHS-theme frequency varied by year: 2005 was dominated by telephone-triage issues; 2010 by a single personal narrative involving a single doctor.

Consequences

The vast majority of articles portray OOHS in a negative tone and nearly half report tragic personal narratives with rare problems. Public perception of OOHS could be skewed with an over-representation of rare cases. Studying the public perception of OOHS based on these newspaper representations could help future service design. Guidelines currently exist for media reporting of suicide and science. We make recommendations for guidelines specific for health service reporting which might support more realistic service perception.