General practitioners who choose to hold GMS contracts with health boards undertake to provide services for their medical card patients for a total of 40 hours per week on five or more days in agreement with the local health board. Doctors are obliged also "to make suitable arrangements to enable contact to be made with him or his locum or deputy outside of normal hours for urgent cases". Services provided to GMS patients out of hours attract extra consultation fees for the doctors involved.
Full out-of-hours services are provided in some health board areas by general practitioner led co-operatives and funding totalling €46.5 million was allocated to health boards between 2000 and 2003 for the development and expansion of these co-operatives. While there has been no formal study of the relationship between availability of night time calls from general practitioners and dependence on accident and emergency services undertaken by my Department, 30% of the users of the co-op service in one health board area indicated that they would have used the accident and emergency department if the co-op had not been an option. It is worth noting that a large percentage of the calls handled by the co-ops are handled by telephone advice either from the nurse or doctor or by centre visits and that only a very small percentage require domiciliary visits by the doctors.
The independent evaluation reports of the service in the North Eastern and South Eastern Health Boards indicated that co-operatives represent an enhancement of service to the patient and that the level of satisfaction among participating general practitioners was also high. Access to the service is by using a lo-call number. There is equal access for both medical card and private patient and the information on any treatment provided is sent electronically to the patient's doctor on the following day. This helps to ensure a continuity of care for the patient.
The co-operative enables the participating GPs to have formal arrangements in place to cope with their contracted out of hours obligations. It helps them achieve a balance between work and life, and at the same time provides them with the back up transport and other services such as suitably equipped cars, drivers and communications.