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BACKGROUND: The number of out-of-hours calls to general practitioners (GPs) has increased steadily during the past 20 years. The proportion of inappropriate calls are reportedly increasing but we know very little about how GPs judge a call to be appropriate or inappropriate. AIM: To determine the factors that influence GPs' perceptions of the appropriateness or inappropriateness of out-of-hours calls. DESIGN OF STUDY: Postal questionnaire survey. SETTING: GP members of the Wessex Primary Care Research Network (WReN) and the Northern Primary Care Research Network (NoReN). METHOD: General Practitioners were asked to write down what they meant by an 'appropriate' and 'inappropriate' out-of-hours call. The free text was subjected to content analysis. RESULTS: Detailed responses were received from 146 (73%) GPs. General practitioners appear to have a well developed classification of the appropriateness of out-of-hours calls. Factors that make calls appropriate include not only the nature of patients' symptoms and illness but also non-medical factors such as patients' compliance and politeness. CONCLUSION: The inclusion by GPs of non-medical factors in their conceptualisation of the appropriateness of out-of-hours calls may contribute to patients' confusion about what is and is not appropriate and also to the apparent failure of patient education initiatives designed to decrease inappropriate demand.