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Family Practice Vol. 21, No. 2, 180-182
Family Practice Vol. 21, No. 2 © Oxford University Press 2004, all rights reserved.

Article

The impact of a general practice co-operative on accident and emergency services, patient satisfaction and GP satisfaction

DM Pickin, A O'Cathain, M Fall, AB Morgana, A Howeb and JP Nicholl

Medical Care Research Unit, a Sheffield Health Economics Group and b Institute of General Practice and Primary Care, School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK

E-mail: d.m.pickin{at}sheffield.ac.uk

Background. The advent of general practice co-operatives represented a fundamental change in the delivery and organization of out-of-hours services. Concerns have been voiced that co-operatives might impact adversely on workload in accident and emergency (A&E) departments.

Objective. The purpose of this study was to assess the impact of establishing a general practice co-operative on use of A&E services, patient satisfaction and GP satisfaction.

Methods. A controlled before and after study of a GP co-operative in Sheffield, UK was carried out. A postal questionnaire was sent to 26 911 people, 13 442 before and 13 469 after the opening of the co-operative, to determine service use, in particular A&E attendance, in the previous 4 weeks. Patient satisfaction was assessed through structured interviews with 653 patients. GP satisfaction was assessed using a postal survey of all 98 Sheffield practices 2 years after the opening of the co-operative.

Results. There was no change in the use of A&E services, odds ratio = 1.08 (95% confidence interval 0.60–1.94). There was no change in patient satisfaction overall, mean difference 0.02 (-0.32 to 0.36). Sixty-seven per cent of doctors in member practices were much more satisfied with out-of-hours duty compared with 10% in non-member practices (P < 0.001).

Conclusions. General practice co-operatives have been successful in achieving their policy objectives, improving GP morale without jeopardizing patient satisfaction or impacting adversely on A&E services.

Keywords. Accident and emergency services, family practice, out of hours, primary health care.


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