Introduction Offering choice about place of care to patients is fundamentally influenced by out-of-hours service provision. Concerns have been raised about continuity, availability of information and access to support services. General practitioners (GPs) provide most care out-of-hours, but see few palliative patients. Keeping knowledge up-to-date is challenging.

Aim(s) and method(s) To explore the views, confidence and educational preferences of out-of-hours GPs in order to inform recommendations for future education. Structured postal survey sent to 1005 GPs across England employed by an independent provider of out-of-hours services.

Results 203 GPs completed the questionnaire (response rate 20.3%). Organisational factors were felt to have significantly greater impact on care delivery than clinical factors (p<0.0005): lack of familiarity, time pressures and lack of information from in-hours services were ranked highest. Confidence in assessing palliative care emergencies (42.8%, n=87: ‘not so confident’ or ‘not at all confident’), managing symptoms in non-cancer patients (39.4%, n=80) and prescribing a new syringe driver (39.0%, n=79) was lowest. Low confidence was associated with infrequent exposure (p<0.05) and lack of training (p<0.05). Educational preferences were strongly associated with confidence (p<0.0005); the above topics were most requested. E-learning was the preferred method (67.5%, n=137). 82.1% (n=165) felt training focused on out-of-hours work would be beneficial.

Conclusion(s) Organisational factors continue to hinder care delivery, but confidence in key palliative care competences is lacking. Educational strategies must be targeted at GPs needs, both in terms of content and delivery. Specialist palliative care services should engage with out-of-hours providers to support education.