ABSTRACT
This chapter considers some of the groups of people who experience particular difficulty in gaining the help they need out of hours. These include: people who may have an urgent need for community-based specialist help and people who have difficulty in communicating needs. The chapter presents a range of complex needs which tend to be inadequately catered for by out-of-hours arrangements. Mental health groups also stated that limited social worker and community psychiatric nurse availability out of hours lead general practitioners (GP) to sometimes seek admission for patients suffering from mental health problems who could otherwise have been maintained in the community. Continuity of care is a key issue for patients with palliative care needs. Primary care groups draw together GP, community nursing, social service and lay perspectives and so provide a new context within which to identify and plan for the out-of-hours needs of groups with special difficulties.
