General practice out-of-hours co-operatives--population contact rates

Since 1998, Irish general practice has developed 11 out-of-hours co-operatives, covering almost 40% of the population. The co-operatives vary in terms of triage mechanisms, treatment centres and domiciliary visits. Out-of-hours consultation rates for the GMS sector of the population (one-third of the population who receive free primary care on the basis of low income) have increased rapidly to 438 consultations/1000 persons/year by 2003. British and Danish out-of-hours co-operatives report annual contact rates of 280-470 contacts/1000 persons per year. The aims were to describe 12 month activity data in the co-operatives and to describe the workload in the context of the population served. A questionnaire survey for a 12 month period was completed by all 11 co-operatives. The results were that almost 340,000 contacts occurred during the period, with 34.0% dealt with by phone advice alone, 53.8% dealt with by visits to treatment centres and 12.3% dealt with by domiciliary visits. The mean population contact rate is 221 contacts/1000 persons/year (range 370-70) and the mean consultation rate is 144 consultations/1000 persons/year. Two distinct bands of contact rates emerged - seven of eight rural co-operatives (all with domiciliary services) have a range of 220-300 contacts/1000 persons/year while three urban co-operatives (none of which have integrated domiciliary services) have a range of 70-90 contacts/1000 persons/year. These results are explored in the context of UK and Danish data, with which they compare. The implications of the urban/rural banding are significant and require early further research.