• GP out-of-hours services manage the vast majority of patients without needing hospital referral
• Only around 13% of contacts resulted in ED referrals
• Demand for GP out-of-hours services increased over time, with a particularly marked rise following the introduction of the under-6s GP care contract in 2015.
• During COVID-19, face-to-face consultations fell substantially, reflecting the rapid shift towards telephone-based clinical assessment and care.
• Emergency Department referral rates remained relatively stable throughout the study period, ranging from 11% to 15%, with an overall average of 13%.
• Triage nurses played an important role in identifying more urgent presentations (eg chest pain, possible stroke, serious injury etc), with 25% of triaged contacts referred directly to an Emergency Department. For contacts assessed as suitable for review by the GP on duty, the subsequent ED referral rate was 10%.

The findings highlight the essential role of GP out-of-hours services in providing urgent care in the community. By managing most presentations without hospital referral, these services support patients to receive timely care close to home and form an important part of Ireland’s urgent and unscheduled care infrastructure.

While over 90% of general practice care is, and should continue to be, delivered during daytime hours, the increasing workload and critical role of GP out-of-hours co-operatives underline the need for sustained investment to maintain accessibility, IT capabilities, quality and resilience in these services.

• Our study aimed to quantify OOH activity (2013–2022), examine for changes in OOH service utilisation over time and describe emergency department (ED) referral rates.
• Prior to this research, national trends in GP out-of-hours workload and hospital referral patterns had not been well described.
• The study analysed data from eight large GP out-of-hours co-operatives in Ireland, collectively delivering approximately one million patient consultations each year across the south, midlands, north and east of the country.
• Five co-operatives were able to provide Emergency Department and ambulance referral outcome data, covering 6.97 million patient consultations over the 10-year study period

• All GPs who care for public patients ensure access to out-of-hours GP care. Approximately 80% of Irish GPs participate in organised out-of-hours co-operatives, while others provide cover through shared rotas or deputising services, ensuring that patients can access GP care during evenings, nights, weekends and bank holidays.
• GP out-of-hours services provide care when daytime general practices are closed, typically from 6pm to 8am on weekdays, and throughout weekends and bank holidays.
• These services, funded by participating GPs and the HSE, provide telephone triage, clinical assessment, advice, treatment and, where required, onward referral to Emergency Departments or ambulance services.