Rural general practitioners' experience of the provision of out-of-hours care: a qualitative study

Background: Published research into the provision and utilisation of out-of-hours services shows long-term trends towards decreasing personal commitment among general practitioners (GPs). However, the on-call commitments of rural GPs remain especially onerous. There has been little research relating to either rural out-of-hours services or the implications of such services for the families of the providers. Aim: To explore and describe how rural GPs in Ireland perceive and experience out-of-hours care provision. Design of study: A qualitative study was conducted with 10 rural GPs and their spouses in their homes or practices using one-to-one in-depth interviews. Setting: Ten general practices in rural Ireland. Method: The interviews were guided by an interview schedule that was based on pertinent themes that had emerged from previous relevant literature. The interviews were audiotaped, transcribed and analysed for themes and issues. Results. Results indicated that rural GPs experience a wide variety of satisfactions from work related to the provision of out-of-hours care. However the large proportion of time committed to out-of-hours care greatly infringes on their social and family life. The key stressors identified related to organisational system difficulties difficulties, especially with regard to locum cover, and unrealistic patient expectations. The stressors were mainly expressed as lack of time of restrictions on family life, and interruptions. Conclusion. System difficulties, such as difficulty with obtaining and rota extension, need to be addressed at an organisational level. Patient expectations of the role of the rural GP have significant implications for practitioners and their families.