Evaluation of a general practice out of hours cooperative: a questionnaire survey of general practitioners

Introduction

General practitioners are increasingly working together in cooperatives to provide out of hours care. What might be the reasons for this development, and how satisfied are doctors with this new way of working? I compared an out of hours cooperative in London with a commercial deputising service. This project is described elsewhere.1 2 This paper describes both general practitioners' satisfaction with each service and the issues that determine which service they chose.

Method and results

I sent an anonymous postal questionnaire to all general practitioners belonging to the cooperative or subscribing to the deputising service. The overall response rate was 72% (202/280), with responses from 80% (111/139) of cooperative users and 65% (91/141) of users of the deputising service. The questionnaire had a Cronbach's α coefficient of 0.79, indicating high reliability. There were no differences between cooperative and deputising service users in terms of age, sex, or practice size, with 23% (45/196) of all respondents practising singlehandedly.

Most of the doctors belonging to the cooperative (62/111 (56%; 95% confidence interval 47% to 65%) had previously used a deputising service. Few of the deputising service users (16/88 (18%; 10% to 26%)) had had the option of joining the cooperative. Of the 116 respondents who had had an alternative, 102 (88%; 82% to 94%) had chosen the cooperative. Two thirds of cooperative users (77/111 (69%; 61% to 78%)) handed over most or all out of hours calls to the service, but only one quarter (22/90 (24%; 16% to 33%)) of deputising service users did so.

Table 1) shows the importance of various factors in doctors' choice of service and their satisfaction with the service provided. Satisfaction seems high with both services, but cooperative service users expressed greater satisfaction, particularly with the quality of prescribing and the duty doctors' reports.

Of the 87 doctors who worked regular sessions for the cooperative, 25 (29%; 19% to 38%) found them more stressful than daytime work in surgery, but 32 (37%; 27% to 47%) found them less stressful. Three quarters (82/110 (75%; 66% to 83%)) of cooperative users felt that membership of the cooperative had improved their relationship with local general practitioners. Among all the respondents 143/197 (73%; 66% to 79%) thought that using their out of hours service improved their enthusiasm for general practice, and 147/197 (75%; 69% to 81%) reported that the service reduced their stress in the daytime.

Most cooperative users (71/111 (64%; 55% to 73%)) had received critical comments from patients about the service, as had 64/90 (71%; 62% to 80%) deputising users. Eight of 101 cooperative users (8%; 3% to 13%), but no deputising service user, had received formal complaints about the service.

Overall, 184/201 (92% (88% to 95%)) of respondents were satisfied or very satisfied with their arrangements for out of hours care, with cooperative members being more satisfied (U=3478, P<0.001). No significant differences were seen in overall satisfaction between respondents of different ages or between male and female doctors.

Comment

The results of this survey may not be generalisable to areas outside London or where the main alternative to a cooperative has been provision of out of hours care by the practice members themselves.

The main reasons that doctors chose to belong to the cooperative were the quality of care that patients receive and the fact that it is run by local general practitioners. Members were very satisfied with their participation in the scheme, and many described considerable benefits to their personal and professional lives. The provision of good quality out of hours services seems to have removed an important cause of demoralisation among general practitioners.3

This may reflect “honeymoon enthusiasm” for the cooperative, which is not necessarily sustainable. Many cooperatives have been established by a few local protagonists, and the long term viability of small non-profit making organisations is uncertain. General practitioners may become less willing to work at night. At present, however, out of hours cooperatives seem highly popular.