ABSTRACT
The advent of co-operatives has transformed on-call provision and appears to have boosted the morale of general practitioners (GP) across much of the United Kingdom. Whilst GPs working in heavily urbanised areas were able to employ commercial deputising services to relieve them of the increasing burden of out-of-hours care, around 60% of GPs had no access to such services. The chapter reviews the development of co-operatives in the context of the cultural, political and regulatory frameworks which influenced and affected their development. Co-operatives are supported by the out-of-hours development fund and membership subscriptions. There are two main areas of activity within a co-operative: the clinical activity of the doctors and the activity of the supporting infrastructure. Most primary care groups will be smaller than the average co-operative and marginally too small for efficient out-of-hours care. Finally, the advent of clinical governance will influence the way in which cooperatives manage themselves.
