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

Fam Pract. 2004 Apr;21(2):180-2. doi: 10.1093/fampra/cmh213.


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.

MeSH terms

  • Delivery of Health Care / organization & administration
  • Delivery of Health Care / statistics & numerical data
  • Emergency Service, Hospital / statistics & numerical data*
  • England
  • Family Practice / organization & administration*
  • Female
  • Follow-Up Studies
  • Group Practice / statistics & numerical data*
  • Health Care Surveys
  • Humans
  • Job Satisfaction*
  • Male
  • Outcome Assessment, Health Care
  • Patient Satisfaction / statistics & numerical data*