Table 1 Features of general practitioner cooperatives at emergency care access points in the Netherlands [1, 2, 4, 23]

General

Out-of-hours primary care is provided by large-scale general practitioner cooperatives (GPC)

Out-of-hours is defined as daily from 5 p.m. to 8 a.m. the entire weekend, and public holidays.

Participation of 50–250 GPs per cooperative with a mean of 4 h on call per week

Population consists of 100,000 to 500,000 patients

At present there are 121 GPCs with yearly about 4 million contacts.

200.000 self-referral contacts a year are registered at the GPCs (5%).

Location

Distance of patients to GPC maximally 30 km

56% of GPCs is co-located with the ED of a hospital, forming an Emergency Care Access Point, 7% is located on the site of the hospital premises (without collaboration), 11% in the vicinity of the hospitals and 26% elsewhere

Accessibility

Access generally via regional telephone number. First contact is mostly telephonic with a triage nurse (90–95%), infrequently as self-referral.

Telephone triage by nurses supervised by GPs: contacts are divided into telephone advice (38%), centre consult (52%), or GP home visit (10%).

Triage outcomes (NTS: Dutch Triage Guidelines): Life threatening (U1) 2%; Acute (U2) 15%: Urgent (U3) 38%; Routine (U4) 18%; Advice (U5) 27%

The GPC in an ECAP is mostly responsible for the face-to-face triage of self-referrals (54%). The ED is responsible for face-to-face triage in 21%. In 15% the triage is performed according to the patients choice. The remaining 10% has a deviant organisation.

In the Netherlands, adult patients have to make an annual deductible (€385,- in 2016) for hospital care and diagnostics. GP and GPC care is fully covered, without a co-payment.

Facilities

Glucose testing and urine examination can be performed at all GPCs. An ECG is available in 26%, conventional radiology in 19% and routine laboratory test in 37–65%.