Study objective -The study aimed to determine the relative risk of being accepted for renal replacement treatment of black and Asian populations compared with whites in relation to age, sex, and underlying cause. The implications for population need for renal replacement therapy in these populations and for the development of renal services were also considered. crude relative acceptance rates compared with whites were 3 5 and 3-2 respectively. Age sex specific relative acceptance ratios increased with age in both ethnic populations and were greater in females. Age standardised acceptance ratios were increased 4-2 and 3-7 times in Asian and black people respectively. The most common underlaying cause in both these populations was diabetes; relative rates of acceptance for diabetic end-stage renal failure were 5 8 and 6 5 respectively. The European Dialysis and Transplant Association coding system was inaccurate for disaggregating non-insulin and insulin dependent forms. "Unknown causes" were an important category in Asians with a relative acceptance ofrate 5 7. The relative rates were reduced only slightly when the comparison was confined to the district health authorities with large ethnic minority populations, suggesting that geographical access was not a major factor in the high rates for ethnic minorities. Conclusion -Acceptance rates for renal replacement treatment are increased significantly in Asian and black populations. Although data inaccuracies and access factors may contribute to these findings, the main reason is probably the higher incidence of end-stage renal failure. This in turn is due to the greater prevalence of underlying diseases such as non-insulin dependent diabetes but possibly also increased susceptibility of developing nethropathy. The main implication is that these populations age demand for renal replacement treatment will increase. This will have an impact nationally but will be particularly apparent in areas with large ethnic minority populations. Future planning must take these factors into account and should include strategies for preventing chronic renal failure, especially that due to non-insulin dependent diabetes and hypertension. The data could not determine the extent to which population need was being met; further studies are required to estimate the incidence of endstage renal failue in ethnic minority populations. (J7 Epidemiol Community Health 1996;50:334-339) Although end-stage renal failure is relatively uncommon, treatment by renal replacement therapy (dialysis or transplantation) is complex, costly, and has to be given lifelong. Without treatment patients die. Provision in the UK has expanded significantly in the past decade. We present data from the national review of renal services in England, the first time a national dataset on ethnicity and uptake of health 334 on 29 April 2019 by guest. Protected by copyright.

Fundamental changes in the delivery of primary medical care outside normal surgery hours are under consideration in Great Britain. Published research into the provision and utilisation of out of hours services shows long term trends towards decreasing personal commitment among general practitioners and rising demand from patients for primary and hospital accident and emergency department care. Wide variations exist regionally, locally, and between practices. Previous studies, however, have been limited in scope and provide an inadequate basis for assessing the potential impact of change. The overall demand for care across all sources of provision cannot be measured: there is a lack of data on costs, and evaluative studies comparing alternative patterns of service delivery have rarely been undertaken. A period of experimentation and evaluation of a range of options should precede the wider adoption of any particular models.

Objective-To determine the use and organisation ofout ofhours services in primary care.Design Only two cooperatives were in areas with extensive use ofdeputising services.Conclusion-Methods of providing out of hours care are changing, and without good information systems family health services authorities will not be able to monitor the effect on quality and cost effectiveness ofcare.