Future provision of out of hours primary medical care: a survey with two general practitioner research networks

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Abstract
Objective: To ascertain general practitioners' views about the future provision of out of hours primary medical care. Design: Self completing postal questionnaire survey. Setting: Wessex and north east England. Subjects: 116 general practitioners in the Wessex Primary Care Research Network and 83 in the Northern Primary Care Research Network. Main outcome measures: Intention to reduce or opt out of on call; plans for changing out of hours arrangements; the three most important changes needed to out of hours care; willingness to try, and perceived strengths and limitations of, three alternative out of hours care models—primary care emergency centres, telephone triage services, and cooperatives. Results: The overall response rate was 74% (Wessex research network 77% (89/116), northern research network 71% (59/83)). Eighty three per cent of respondents (123/148) were willing to try at least one service model, primary care emergency centres being the most popular option. Key considerations were the potential for a model to reduce time on call and workload, to maintain continuity of care, and to fit the practice context. Sixty one per cent (91/148) hoped to reduce time on call and 25% (37/148) hoped to opt out completely. Conclusion: General practitioners were keen to try alternative arrangements for out of hours care delivery, despite the lack of formal trials. The increased flexibility in funding brought about by the recent agreement between the General Medical Services Committee and the Department of Health is likely to lead to a proliferation of different schemes. Careful monitoring will be necessary, and formal trials of new service models are needed urgently. Key messages Over 80% of general practitioners in two research networks were willing to try a new out of hours service for their practice—either a primary care emergency centre, a telephone triage service, or a cooperative; cooperatives were the least favoured option The most important changes needed to out of hours care concerned financial arrangements, regulations, and patient education Formal trials of new services are needed before the opportunity to collect baseline data is lost