title: GPs' experiences with out-of-hours GP cooperatives: a survey study from the Netherlands.
abstract: BACKGROUND
  Out-of-hours primary care has been provided by general practitioner (GP) cooperatives since the year 2000 in the Netherlands. Early studies in countries with similar organizational structures showed positive GP experiences. However, nowadays it is said that GPs experience a high workload at the cooperative and that they outsource a considerable part of their shifts.
  
  
  OBJECTIVE
  To examine positive and negative experiences of GPs providing out-of-hours primary care, and the frequency and reasons for outsourcing shifts.
  
  
  METHODS
  A cross-sectional observational survey among 688 GPs connected to six GP cooperatives in the Netherlands, using a web-based questionnaire.
  
  
  RESULTS
  The response was 55% (n = 378). The main reasons for working in GP cooperatives were to retain registration as GP (79%) and remain experienced in acute care (74%). GPs considered the peak hours (81%) and the high number of patients (73%) as the most negative aspects. Most GPs chose to provide the out-of-hours shifts themselves: 85% outsourced maximally 25% of their shifts. The percentage of outsourced shifts increased with age. Main reasons for outsourcing were the desire to have more private time (76%); the high workload in daytime practice (71%); and less the workload during out-of-hours (46%).
  
  
  CONCLUSIONS
  GPs are motivated to work in out-of-hours GP cooperatives, and they outsource few shifts. GPs consider the peak load and the large number of (non-urgent) help requests as the most negative aspects. To motivate and involve GPs for 7 × 24-h primary care, it is important to set limits on their workload.
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre , Nijmegen , The Netherlands.
authors.forename: Marleen
authors.initials: M
authors.lastname: Smits
authors.forename: Ellen
authors.initials: E
authors.lastname: Keizer
authors.forename: Linda
authors.initials: L
authors.lastname: Huibers
authors.forename: Paul
authors.initials: P
authors.lastname: Giesen
mesh_terms: D039602:After-Hours Care / Q000458:organization & administration*; D000367:Age Factors; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D005260:Female; D058006:General Practice / Q000458:organization & administration*; D058005:General Practitioners / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D020416:Outsourced Services / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D016526:Workload
keywords: emergency; experiences; general practitioners; out-of-hours care; primary care