Open Access Research article

What's the effect of the implementation of general practitioner cooperatives on caseload? Prospective intervention study on primary and secondary care

Hilde Philips1*, Roy Remmen1, Paul Van Royen1, Marc Teblick2, Leo Geudens2, Marc Bronckaers3 and Herman Meeuwis4

Author Affiliations

1 University of Antwerp, Department of General Practice, Interdisciplinary Care and Geriatrics, Universiteitsplein 1, Gebouw R, 3de verd. B-2610 Wilrijk, Belgium

2 Huisartsenvereniging Regio Turnhout (HVRT), Campus Blairon 410, B-2300 Turnhout, Belgium

3 Algemeen Ziekenhuis Sint Jozef, Steenweg op Merksplas 44, B-2300 Turnhout, Belgium

4 Sint Elisabeth Ziekenhuis, Rubensstraat 166, B-2300 Turnhout, Belgium

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BMC Health Services Research 2010, 10:222  doi:10.1186/1472-6963-10-222

Published: 30 July 2010



Out-of-hours care in the primary care setting is rapidly changing and evolving towards general practitioner 'cooperatives' (GPC). GPCs already exist in the Netherlands, the United Kingdom and Scandinavia, all countries with strong general practice, including gatekeepers' role. This intervention study reports the use and caseload of out-of-hours care before and after implementation of a GPC in a well subscribed region in a country with an open access health care system and no gatekeepers' role for general practice.


We used a prospective before/after interventional study design. The intervention was the implementation of a GPC.


One year after the implementation of a GPC, the number of patient contacts in the intervention region significantly increased at the GPC (OR: 1.645; 95% CI: 1.439-1.880), while there were no significant changes in patient contacts at the Emergency Department (ED) or in other regions where a simultaneous registration was performed. Although home visits decreased in all general practitioner registrations, the difference was more pronounced in the intervention region (intervention region: OR: 0.515; 95% CI: 0.411-0.646, other regions: OR: 0.743; 95% CI: 0.608-0.908). At the ED we observed a decrease in the number of trauma cases (OR: 0.789; 95% CI: 0.648-0.960) and of patients who came to hospital by ambulance (OR: 0.687; 95% CI: 0.565-0.836).


One year after its implementation more people seek help at the GPC, while the number of contacts at the ED remains the same. The most prominent changes in caseload are found in the trauma cases. Establishing a GPC in an open health care system, might redirect some patients with particular medical problems to primary care. This could lead to a lowering of costs or a more cost-effective out of hours care, but further research should focus on effective usage to divert patient flows and on quality and outcome of care.