Article Text
Abstract
Aim To explore interpretations of “appropriate” and “inappropriate” elective referral from primary to secondary surgical care among senior clinical and non-clinical managers in five purposively sampled primary care trusts (PCTs) and their main associated acute hospitals in the English National Health Service (NHS).
Methods Semi-structured face-to-face interviews were undertaken with senior managerial staff from clinical and non-clinical backgrounds. Interviews were tape-recorded, transcribed and analysed according to the Framework approach developed at the National Centre for Social Research using N6 (NUD*IST6) qualitative data analysis software.
Results Twenty-two people of 23 approached were interviewed (between three and five respondents per PCT and associated acute hospital). Three attributes relating to appropriateness of referral were identified: necessity: whether a patient with given characteristics was believed suitable for referral; destination or level: where or to whom a patient should be referred; and quality (or process): how a referral was carried out, including (eg, investigations undertaken before referral, information contained in the referral and extent of patient involvement in the referral decision. Attributes were hierarchical. “Necessity” was viewed as the most fundamental attribute, followed by “destination” and, finally, “quality”. In general, but not always, all three attributes were perceived as necessary for a referral to be defined as appropriate.
Conclusions For senior clinical and non-clinical managers at the local level in the English NHS,, three hierarchical attributes (necessity, appropriateness of destination and quality of referral process) contributed to the overall concept of appropriateness of referral from primary to secondary surgical care.
- Referral
- appropriateness
- primary–secondary care interface
- guidelines
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
Statistics from Altmetric.com
Footnotes
Funding Funding was obtained from the NIHR R&D SDO Programme. The National Co-ordinating Centre for the NIHR Service Delivery and Organisation Programme (NCCSDO), London School of Hygiene and Tropical Medicine, 99 Gower Street, London WC1E 6AA, UK, tel: 020 7612 7980; fax: 020 7612 7979; email: sdo@lshtm.ac.uk. We are grateful for the comments of our referees.
Competing interests None.
Patient consent Obtained.
Ethical approval was obtained from the Multi Research Ethics Committee (MREC) for Scotland.
Provenance and peer review Not commissioned; externally peer reviewed.