The relationship between GPs and hospital consultants and the implications for patient care: a qualitative study

Rod Sampson; Rosaline Barbour; Philip Wilson

doi:10.1186/s12875-016-0442-y

The relationship between GPs and hospital consultants and the implications for patient care: a qualitative study

Rod Sampson, Rosaline Barbour, Philip Wilson

Research output: Contribution to journal › Article › peer-review

43 Citations (Scopus)

7 Downloads (Pure)

Abstract

BACKGROUND: Improving the quality of care of at the medical primary-secondary care interface is both a national and a wider concern. In a qualitative exploration of clinicians' relationship at the interface, we want to study how both GPs and hospital specialists regard and behave towards each other and how this may influence patient care.

METHOD: A qualitative interview study was carried out in primary and secondary care centres in NHS Highland health board area, Scotland. Eligible clinicians (general practitioners and hospital specialists) were invited to take part in a semi-structured interview to explore the implications of interface relationships upon patient care. A standard thematic analysis was used, involving an iterative process based on grounded theory.

RESULTS: Key themes that emerged for clinicians included communication (the importance of accessing and listening to one another, and the transfer of soft intelligence), conduct (referring to perceived inappropriate transfer of workload at the interface, and resistance to this transfer), relationships (between interface clinicians and between clinicians and their patients), and unrealistic expectations (clinicians expressing idealistic hopes of what their colleagues at the other interface could achieve).

CONCLUSION: The relationship between primary and secondary care clinicians, and, in particular, difficulties and misunderstandings can have an influence upon patient care. Addressing key areas identified in the study may help to improve interface relationships and benefit patient care.

Original language	English
Article number	45
Journal	BMC Family Practice
Volume	17
DOIs	https://doi.org/10.1186/s12875-016-0442-y
Publication status	Published - 14 Apr 2016

Bibliographical note

Acknowledgements
Clinicians assisting development of topic guide, all based in NHS Highland; Mr Angus Cain (Consultant Ear, Nose & Throat), Professor Steve Leslie (Consultant Cardiologist), Professor Ronald Macvicar (Postgraduate Dean, North of Scotland Region of NHS Education for Scotland (NES)), Dr Jerry O’Rourke (General Practice Principal), Professor Ken Walker (Consultant Colorectal surgeon). Clinicians involved in pilot of the semi-structured questionnaire; Dr Beth Macfarlane (General Practice Principal), and Dr Russell Drummond (Consultant Endocrinologist). Gillian Heron, Cairn Medical Practice who transcribed interview recordings.

Funding
The research was funded by both the local NHS Highland Research & Development Committee, and the “RCGP Allen & Margaret Wilson Memorial Fund.” The Chief Investigator (Dr Rod Sampson) received no personal payment for the study. No drug company is involved in this research.

Keywords

Attitude of Health Personnel
Consultants
Female
General Practitioners
Humans
Interprofessional Relations
Interviews as Topic
Male
Patient Care
Primary Health Care
Qualitative Research
Referral and Consultation
Scotland
Secondary Care
Specialization
State Medicine
Journal Article
Research Support, Non-U.S. Gov't

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10.1186/s12875-016-0442-yLicence: CC BY

The relationship between GPs and hospital consultants and the implications for patient care
© 2016 Sampson et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated
Final published version, 527 KBLicence: CC BY

Philip Wilson
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Emeritus Professor
Person: Honorary

Cite this

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abstract = "BACKGROUND: Improving the quality of care of at the medical primary-secondary care interface is both a national and a wider concern. In a qualitative exploration of clinicians' relationship at the interface, we want to study how both GPs and hospital specialists regard and behave towards each other and how this may influence patient care.METHOD: A qualitative interview study was carried out in primary and secondary care centres in NHS Highland health board area, Scotland. Eligible clinicians (general practitioners and hospital specialists) were invited to take part in a semi-structured interview to explore the implications of interface relationships upon patient care. A standard thematic analysis was used, involving an iterative process based on grounded theory.RESULTS: Key themes that emerged for clinicians included communication (the importance of accessing and listening to one another, and the transfer of soft intelligence), conduct (referring to perceived inappropriate transfer of workload at the interface, and resistance to this transfer), relationships (between interface clinicians and between clinicians and their patients), and unrealistic expectations (clinicians expressing idealistic hopes of what their colleagues at the other interface could achieve).CONCLUSION: The relationship between primary and secondary care clinicians, and, in particular, difficulties and misunderstandings can have an influence upon patient care. Addressing key areas identified in the study may help to improve interface relationships and benefit patient care.",

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N1 - Acknowledgements Clinicians assisting development of topic guide, all based in NHS Highland; Mr Angus Cain (Consultant Ear, Nose & Throat), Professor Steve Leslie (Consultant Cardiologist), Professor Ronald Macvicar (Postgraduate Dean, North of Scotland Region of NHS Education for Scotland (NES)), Dr Jerry O’Rourke (General Practice Principal), Professor Ken Walker (Consultant Colorectal surgeon). Clinicians involved in pilot of the semi-structured questionnaire; Dr Beth Macfarlane (General Practice Principal), and Dr Russell Drummond (Consultant Endocrinologist). Gillian Heron, Cairn Medical Practice who transcribed interview recordings. Funding The research was funded by both the local NHS Highland Research & Development Committee, and the “RCGP Allen & Margaret Wilson Memorial Fund.” The Chief Investigator (Dr Rod Sampson) received no personal payment for the study. No drug company is involved in this research.

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N2 - BACKGROUND: Improving the quality of care of at the medical primary-secondary care interface is both a national and a wider concern. In a qualitative exploration of clinicians' relationship at the interface, we want to study how both GPs and hospital specialists regard and behave towards each other and how this may influence patient care.METHOD: A qualitative interview study was carried out in primary and secondary care centres in NHS Highland health board area, Scotland. Eligible clinicians (general practitioners and hospital specialists) were invited to take part in a semi-structured interview to explore the implications of interface relationships upon patient care. A standard thematic analysis was used, involving an iterative process based on grounded theory.RESULTS: Key themes that emerged for clinicians included communication (the importance of accessing and listening to one another, and the transfer of soft intelligence), conduct (referring to perceived inappropriate transfer of workload at the interface, and resistance to this transfer), relationships (between interface clinicians and between clinicians and their patients), and unrealistic expectations (clinicians expressing idealistic hopes of what their colleagues at the other interface could achieve).CONCLUSION: The relationship between primary and secondary care clinicians, and, in particular, difficulties and misunderstandings can have an influence upon patient care. Addressing key areas identified in the study may help to improve interface relationships and benefit patient care.

AB - BACKGROUND: Improving the quality of care of at the medical primary-secondary care interface is both a national and a wider concern. In a qualitative exploration of clinicians' relationship at the interface, we want to study how both GPs and hospital specialists regard and behave towards each other and how this may influence patient care.METHOD: A qualitative interview study was carried out in primary and secondary care centres in NHS Highland health board area, Scotland. Eligible clinicians (general practitioners and hospital specialists) were invited to take part in a semi-structured interview to explore the implications of interface relationships upon patient care. A standard thematic analysis was used, involving an iterative process based on grounded theory.RESULTS: Key themes that emerged for clinicians included communication (the importance of accessing and listening to one another, and the transfer of soft intelligence), conduct (referring to perceived inappropriate transfer of workload at the interface, and resistance to this transfer), relationships (between interface clinicians and between clinicians and their patients), and unrealistic expectations (clinicians expressing idealistic hopes of what their colleagues at the other interface could achieve).CONCLUSION: The relationship between primary and secondary care clinicians, and, in particular, difficulties and misunderstandings can have an influence upon patient care. Addressing key areas identified in the study may help to improve interface relationships and benefit patient care.

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KW - Primary Health Care

KW - Qualitative Research

KW - Referral and Consultation

KW - Scotland

KW - Secondary Care

KW - Specialization

KW - State Medicine

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

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DO - 10.1186/s12875-016-0442-y

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SN - 1471-2296

VL - 17

JO - BMC Family Practice

JF - BMC Family Practice

M1 - 45

ER -

The relationship between GPs and hospital consultants and the implications for patient care: a qualitative study

Abstract

Bibliographical note

Keywords

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Philip Wilson

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