Referrals and relationships: in-practice referrals meetings in a general practice

G. Rowlands et al., Referrals and relationships: in-practice referrals meetings in a general practice, FAM PRACT, 18(4), 2001, pp. 399-406
Citations number
Categorie Soggetti
General & Internal Medicine
Journal title
ISSN journal
0263-2136 → ACNP
Year of publication
399 - 406
SICI code
Background. GP referrals to secondary care are an important factor in the c ost of running the NHS. The known variation in referral rates between docto rs has the potential to cause tension within primary care which will be exa cerbated by the latest reorganization of primary care and the trend towards capitation-based budgets. The importance of postgraduate learning for GPs has been recognized; continuing professional development is moving towards self-directed practice-based learning programmes. Educational interventions have been shown to alter doctors' prescribing behaviour. This, together wi th the pressure on accounting for referral activity, makes the prospect of improving, and possibly reducing, referral activity through educational int erventions very attractive. Objectives. This study complemented a randomized controlled trial (RCT) whi ch investigated whether an intervention of the type which had reduced presc ribing costs would have a similar effect on referral activity. Methods. The context of the study, description of the characteristics of th e practice and the issues seen as important by the doctors and practice man ager were identified through preliminary semi-structured interviews. The pr actice then held a series of educational in-practice meetings to discuss re ferrals and issues arising from referrals. The audio- and videotaped transc ripts were interpreted using content and group dynamic analysis. Participan ts commented upon our preliminary findings. In addition, we used dimensiona l analysis to induce a preliminary theory describing the effect of the inte rvention on this general practice which enabled us to review the findings o f the parallel RCT. The educational value of the meetings and the learning needs of the participants were also assessed. Results. Our complementary study showed no alteration of practice referral rates following the educational intervention. The qualitative study, unencu mbered by the assumptions inherent in the development of the hypothesis tes ted in the RCT, highlighted the complexity of decision making in general pr actice and the likely impact of historical background and a variety of inte rnal and external pressures on this self-directive educational intervention . The practice members described the individual and group learning needs id entified as a result of the meetings. Conclusion. The findings of this study raise important questions for develo ping practice-based learning. The outcomes of self-directive interventions in practices will be influenced by internal and external events both past a nd present. Such outcomes may be qualitative and difficult to measure. They are likely to differ from outcomes seen when interventions are applied to groups of doctors who are not all members of the same practice.