Out-of-hours co-operatives: General practitioner satisfaction with governance and working arrangements

Objective. General practice co-operatives have led to significant improvements in quality of life for general practitioners.
Little is known about general practitioners’ own experiences with the working arrangements and governance of
co-operatives. This study investigates GP satisfaction, the working environment, governance and future developments in
co-operatives. Methods. A questionnaire was sent to GPs in two co-operatives in the Republic of Ireland, covering mixed
urban and rural areas. Results. Of 221 GPs in the co-operatives, 82% responded and confirmed the co-operatives’ positive
effects on their lives. However, 57% still received requests for out-of-hours care while off duty, most commonly from
patients who preferred to see their own doctor. Half felt overburdened by out-of-hours work, especially those over 40 y of
age. Twenty-five per cent were dissatisfied with the GP complaints mechanism. The majority (63%) would prefer a GP/
health board partnership for the organization of out of hours, while 23% wanted sole responsibility. GPs indicated a strong
need for better ancillary services such as nursing, mental health, dentistry, pharmacy and social work. Access to records is an
important issue in terminal care and mental illness. Conclusion. While GP co-operatives are a success story for general
practice, they will work better for general practitioners and their patients if nursing, mental health, dentistry, pharmacy and
social services are improved. Support and training is needed in mental health, palliative and emergency care to increase
competence and reduce stress. GPs are willing to work with health authorities in further co-operative development. More
attention needs to be paid to the complaints and suggestions of GPs in the running and governance of their co-operatives.