Economic influences on GPs’ decisions to provide out-of-hours care

Claudia Geue, Diane Skatun, Matt Sutton

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background

Introduction of the new general medical services contract offered UK general practices the option to discontinue providing out-of-hours (OOH) care. This aimed to improve GP recruitment and retention by offering a better work-life balance, but put primary care organisations under pressure to ensure sustainable delivery of these services. Many organisations arranged this by re-purchasing provision from individual GPs.

Aim

To analyse which factors influence an individual GP's decision to re-provide OOH care when their practice has opted out.

Design of study

Cross-sectional questionnaire survey.

Setting

Rural and urban general practices in Scotland, UK.

Method

A postal survey was sent to all GPs working in Scotland in 2006, with analyses weighted for differential response rates. Analysis included logistic regression of individuals' decisions to re-provide OOH care based on personal characteristics, work and non-work time commitments, income from other sources, and contracting primary care organisation.

Results Of the 1707 GPs in Scotland whose practice had opted out, 40.6% participated in OOH provision. Participation rates of GPs within primary care organisations varied from 16.7% to 74.7%. Males with young children were substantially more likely to participate than males without children (odds ratio [OR] 2.44, 95% confidence interval [CI] = 1.36 to 4.40). GPs with higher-earning spouses were less likely to participate. This effect was reinforced if GPs had spouses who were also GPs (OR 0.52, 95% CI = 0.37 to 0.74). GPs with training responsibilities (OR 1.36, 95% CI = 1.09 to 1.71) and other medical posts (OR 1.38, 95% CI = 1.09 to 1.75) were more likely to re-provide OOH services.

Conclusion

The opportunity to opt out of OOH care has provided flexibility for GPs to raise additional income, although primary care organisations vary in the extent to which they offer these opportunities. Examining intrinsic motivation is an area for future study.

Original languageEnglish
Pages (from-to)e1-e7
Number of pages7
JournalThe British Journal of General Practice
Volume59
Issue number558
DOIs
Publication statusPublished - 1 Jan 2009

Keywords

  • health care reform
  • out-of-hours medical care
  • primary care
  • workforce
  • preferences

Cite this

Economic influences on GPs’ decisions to provide out-of-hours care. / Geue, Claudia; Skatun, Diane; Sutton, Matt.

In: The British Journal of General Practice, Vol. 59, No. 558, 01.01.2009, p. e1-e7.

Research output: Contribution to journalArticle

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abstract = "BackgroundIntroduction of the new general medical services contract offered UK general practices the option to discontinue providing out-of-hours (OOH) care. This aimed to improve GP recruitment and retention by offering a better work-life balance, but put primary care organisations under pressure to ensure sustainable delivery of these services. Many organisations arranged this by re-purchasing provision from individual GPs.AimTo analyse which factors influence an individual GP's decision to re-provide OOH care when their practice has opted out.Design of studyCross-sectional questionnaire survey.SettingRural and urban general practices in Scotland, UK.MethodA postal survey was sent to all GPs working in Scotland in 2006, with analyses weighted for differential response rates. Analysis included logistic regression of individuals' decisions to re-provide OOH care based on personal characteristics, work and non-work time commitments, income from other sources, and contracting primary care organisation.Results Of the 1707 GPs in Scotland whose practice had opted out, 40.6{\%} participated in OOH provision. Participation rates of GPs within primary care organisations varied from 16.7{\%} to 74.7{\%}. Males with young children were substantially more likely to participate than males without children (odds ratio [OR] 2.44, 95{\%} confidence interval [CI] = 1.36 to 4.40). GPs with higher-earning spouses were less likely to participate. This effect was reinforced if GPs had spouses who were also GPs (OR 0.52, 95{\%} CI = 0.37 to 0.74). GPs with training responsibilities (OR 1.36, 95{\%} CI = 1.09 to 1.71) and other medical posts (OR 1.38, 95{\%} CI = 1.09 to 1.75) were more likely to re-provide OOH services.ConclusionThe opportunity to opt out of OOH care has provided flexibility for GPs to raise additional income, although primary care organisations vary in the extent to which they offer these opportunities. Examining intrinsic motivation is an area for future study.",
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N2 - BackgroundIntroduction of the new general medical services contract offered UK general practices the option to discontinue providing out-of-hours (OOH) care. This aimed to improve GP recruitment and retention by offering a better work-life balance, but put primary care organisations under pressure to ensure sustainable delivery of these services. Many organisations arranged this by re-purchasing provision from individual GPs.AimTo analyse which factors influence an individual GP's decision to re-provide OOH care when their practice has opted out.Design of studyCross-sectional questionnaire survey.SettingRural and urban general practices in Scotland, UK.MethodA postal survey was sent to all GPs working in Scotland in 2006, with analyses weighted for differential response rates. Analysis included logistic regression of individuals' decisions to re-provide OOH care based on personal characteristics, work and non-work time commitments, income from other sources, and contracting primary care organisation.Results Of the 1707 GPs in Scotland whose practice had opted out, 40.6% participated in OOH provision. Participation rates of GPs within primary care organisations varied from 16.7% to 74.7%. Males with young children were substantially more likely to participate than males without children (odds ratio [OR] 2.44, 95% confidence interval [CI] = 1.36 to 4.40). GPs with higher-earning spouses were less likely to participate. This effect was reinforced if GPs had spouses who were also GPs (OR 0.52, 95% CI = 0.37 to 0.74). GPs with training responsibilities (OR 1.36, 95% CI = 1.09 to 1.71) and other medical posts (OR 1.38, 95% CI = 1.09 to 1.75) were more likely to re-provide OOH services.ConclusionThe opportunity to opt out of OOH care has provided flexibility for GPs to raise additional income, although primary care organisations vary in the extent to which they offer these opportunities. Examining intrinsic motivation is an area for future study.

AB - BackgroundIntroduction of the new general medical services contract offered UK general practices the option to discontinue providing out-of-hours (OOH) care. This aimed to improve GP recruitment and retention by offering a better work-life balance, but put primary care organisations under pressure to ensure sustainable delivery of these services. Many organisations arranged this by re-purchasing provision from individual GPs.AimTo analyse which factors influence an individual GP's decision to re-provide OOH care when their practice has opted out.Design of studyCross-sectional questionnaire survey.SettingRural and urban general practices in Scotland, UK.MethodA postal survey was sent to all GPs working in Scotland in 2006, with analyses weighted for differential response rates. Analysis included logistic regression of individuals' decisions to re-provide OOH care based on personal characteristics, work and non-work time commitments, income from other sources, and contracting primary care organisation.Results Of the 1707 GPs in Scotland whose practice had opted out, 40.6% participated in OOH provision. Participation rates of GPs within primary care organisations varied from 16.7% to 74.7%. Males with young children were substantially more likely to participate than males without children (odds ratio [OR] 2.44, 95% confidence interval [CI] = 1.36 to 4.40). GPs with higher-earning spouses were less likely to participate. This effect was reinforced if GPs had spouses who were also GPs (OR 0.52, 95% CI = 0.37 to 0.74). GPs with training responsibilities (OR 1.36, 95% CI = 1.09 to 1.71) and other medical posts (OR 1.38, 95% CI = 1.09 to 1.75) were more likely to re-provide OOH services.ConclusionThe opportunity to opt out of OOH care has provided flexibility for GPs to raise additional income, although primary care organisations vary in the extent to which they offer these opportunities. Examining intrinsic motivation is an area for future study.

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