title: Economic influences on GPs' decisions to provide out-of-hours care.
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.
  
  
  OBJECTIVE
  To analyse which factors influence an individual GP's decision to re-provide OOH care when their practice has opted out.
  
  
  METHODS
  Cross-sectional questionnaire survey.
  
  
  METHODS
  Rural and urban general practices in Scotland, UK.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Health Economics Research Unit, University of Aberdeen, Aberdeen. c.geue@abdn.ac.uk
authors.forename: Claudia
authors.initials: C
authors.lastname: Geue
authors.forename: Diane
authors.initials: D
authors.lastname: Skåtun
authors.forename: Matt
authors.initials: M
authors.lastname: Sutton
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003657:Decision Making; D005190:Family; D005194:Family Practice / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D018166:Health Care Reform / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012423:Rural Health; D012606:Scotland; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014504:Urban Health