This review of GP Out of Hours’ Services is the first national review to be undertaken since the commencement of publicly funded GP Cooperatives in Ireland in 1999. The progress in the establishment of GP cooperatives since then is considered by the HSE to be a highly significant quality initiative for patient care, general practice and the health service as a whole. In the context of the need for the HSE, to meet targets for efficiency savings, to protect services and deliver maximum operational efficiency, this review provided an opportunity to consider the nine national GP cooperatives and the four extended hours’ services in Dublin South City. The recommendations of the review group are challenging and will require a significant level of commitment to implement. It is therefore imperative that responsibility for the implementation of this report remains at regional level. I would like to offer my ongoing support to the Regional Directors of Operations to facilitate their implementation within the Regional Directorates. I would like to take this opportunity to thank the members of the Review Group for their expertise, professionalism and commitment. I also thank the representatives of the GP cooperatives who met with the Review Group and provided us with great insight into the operation of this service provision, the challenges and the opportunities. I also wish to acknowledge the service managers who provided data on an ongoing basis throughout the period of the review. [From forward, Tadhg O’Brien, Assistant National Director,Integrated Services Directorate,Health Services Executive]