Authors' objectives:

This study aimed to describe:

1. The development of cooperatives, their structure, organisation and finances.

2. The patterns of care provided.

3. The attitudes and experiences of service providers and users.

4. Stakeholders' views of the strengths and weaknesses of cooperatives.

Authors' results and conclusions: Reasons for establishing cooperatives Most members established and joined cooperatives with the aim of reducing their hours on call. GPs viewed the change as essential to: improve their quality of life; meet the rising demand; increase the attraction of general practice as a career choice; and aid recruitment in their own practice. Their concerns included: heavy workload for the duty rotas; increased travel distance resulting in delays in reaching patients; and varying standards of care. Organisational features The 16 emergency centres were located in community hospitals (5), A&E departments (2), other hospital departments (2), GP health centres (2), community health clinics (2), purpose-built/converted premises (2), and an ambulance station. Average shift commitments ranged from 1.5 to 4.2 per month. It was usual to have only one GP on duty a night in each centre, covering 30,000-180,000 patients, though a second GP might be on call if needed. Patterns of work On average, the cooperatives studied visited 26% of callers, saw 30% at the centre, and advised 40% by telephone.

Authors' recommendations: Cooperatives have improved the quality of life for GP members by reducing out-of-hours commitments and professional isolation. Patients attending cooperative centres are as satisfied with their treatment as those visited at home and more satisfied with response times. However, rising demand means that cooperative members fear a step towards 24-hour access to routine care with associated problems of increasing rota commitments for GPs. Wide variations in patterns of care and response times lead to questions of equity and safety and this is clearly an area that needs to be addressed. At present there is no single model for the future to which all stakeholders in emergency care would subscribe.

Authors' methods: Case study

Project Status: Completed

URL for project: http://www.hta.ac.uk/900

Year Published: 1999

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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