What does GP out of hours care cost? An analysis of different models of out of hours care in Scotland

Background: The changes to out of hours care provided by General Practitioners have led to wide variation in the types and costs of out of hours care across the country. Aim: To examine the costs of different models of service delivery for GP out of hours organisations. Methods: This was a prospective cross-sectional survey of eight GP out of hours organisations and samples of their patients. A deputising service, rotas, and various types of GP co-operative across Scotland were surveyed. Information on the quantities of resources used by each organisation was combined with unit costs. Costs incurred by patients and other NHS costs subsequent to the out of hours contact were also calculated. Results: Annual costs incurred by the GP out of hours organisation per 1,000 population ranged from £2,916 to £12,120. There was no relationship between costs and type and size of organisation. There was a three-fold variation in total costs per out of hours contact (£15 to £51). Costs per phone contact were lowest (£6 to £ 11), followed by cost per centre contact (£10 to £16) and cost per home contact (£21 to £60). Total costs per episode ranged from £78 to £136 for centre contacts, from £130 to £303 for home contacts, and from £70 to £553 for telephone contacts. Home contacts had the highest average cost per episode (£212), followed by telephone contacts (£117) and centre contacts (£85). Conclusions: There are wide variations in the costs of operating GP out of hours services. It is likely that the context in which organisations were set up and local geography influence variations in costs, as well as the level of GP cover.