Emergency admissions to hospital at night and weekends are distressing for patients and disruptive for hospitals. Many of these admissions result from referrals from GP out-of-hours (OOH) providers. AimTo compare rates of referral to hospital for doctors working OOH before and after the new general medical services contract was introduced in Bristol in 2005; to explore the attitudes of GPs to referral to hospital OOH; and to develop an understanding of the factors that influence GPs when they refer patients to hospital. Design of studyCross-sectional comparison of admission rates; postal survey. SettingThree OOH providers in south-west England. MethodReferral rates were compared for 234 GPs working OOH, and questionnaires explored their attitudes to risk.

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