Background In the Dutch health care system, general practitioners (GPs) are gatekeepers for secondary health care. A referral is needed before consulting a medical specialist. In 20 Dutch regions Medical Coordinating centres develop Regional Agreements (RAs) about patient care at the interface between primary and secondary health care. Ideally, national evidence-based guidelines are used as the basis for RAs.

Objectives To provide insight into the usefulness of national guidelines in the development of RAs.

Methods Qualitative semi-structured interviews were conducted in 2009 with medical coordinators (N = 9), GPs (N = 16) and medical specialists (N = 14), from seven coordinating centres. All participated in developing an RA about different subjects (hematuria, gastroscopy, postmenopausal bleeding, stroke or exercise ECGs). The recorded interviews were transcripted, encoded and analysed in MAXQDA.

Results National guidelines were used in the development of most RAs. GPs and medical specialists reported to use national guidelines from their own (monodisciplinary) organisation. Medical coordinators introduced the most national guidelines. Developing or revising an RA often started on the occasion of a newly published or revised national guideline. The problems in the use of national guidelines are: limited information about cooperation, conflicting information between different guidelines, no trust in the guideline development procedure, and guidelines are not up to date.

Discussion National guidelines have an important role in the development of RAs. National guidelines should pay more attention to recommendations for regional collaboration.

Implications After the development of a national guideline, the developers should keep in touch with GPs and medical specialists in the regions to pick-up their implementation problems.