title: The impact of a general practice co-operative on accident and emergency services, patient satisfaction and GP satisfaction.
abstract: 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.
authors.affiliation: Medical Care Research Unit, Sheffield Health Economics Group and Institute of General Practice and Primary Care, School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK. d.m.pickin@sheffield.ac.uk
authors.forename: D M
authors.initials: DM
authors.lastname: Pickin
authors.forename: A
authors.initials: A
authors.lastname: O'Cathain
authors.forename: M
authors.initials: M
authors.lastname: Fall
authors.forename: A B
authors.initials: AB
authors.lastname: Morgan
authors.forename: A
authors.initials: A
authors.lastname: Howe
authors.forename: J P
authors.initials: JP
authors.lastname: Nicholl
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006123:Group Practice / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data*