Within-practice educational meetings and GP referrals to secondary care: An aid to reflection and review of clinical practice

Gill Rowlands, Jane Sims, Sally Kerry, David Keene, Sean Hilton

Research output: Contribution to journalArticlepeer-review

Abstract

Referrals from GPs to specialist services are central to patient care. The referral decision-making process is complex and influenced by several factors, many of which lie within general practice; it is thus an ideal subject for practice-based education. This paper describes doctors' feedback on a series of within-house referrals meetings. The meetings took place as part of a randomised controlled trial (RCT) to assess the impact of the meetings on practice referral rates, and a parallel qualitative study looking at the meetings in more detail in one practice. The study took place in practices with four or more partners in the North and South Thames regions. Between four and eight meetings were held in each practice. The meetings were based on andragogic principles with guideline educational objectives. Twenty-six practices were recruited to the RCT; of these, 13 were allocated to the educational meetings (intervention arm of the study). The mean number of hours of referrals meetings held in each practice was 5.3 (range 3-10). The mean score for the educational value of the meetings was 6.7 (range 4.4-8) (0 = no value, 10 = extremely valuable). The main benefit described by the doctors was the opportunity to discuss problems with their partners. They described learning from each other and developing new referrals pathways. Fifty-two doctors (88%) felt that the meetings had changed their referrals practice; most commonly via use of their partners' skills and increased personal tolerance of clinical uncertainty. The meetings had no significant effect on the referral rates of the practices. The recruitment to this study was low, raising concerns about the generalisability of the findings. Despite this, the feedback from the participating doctors is sufficiently notable to make this a suitable subject for further study. The emergence of primary care trusts provides an opportunity for skills to be shared across localities to improve patient care. Any changes may be complex and difficult to demonstrate through relatively insensitive measurements, such as referral activity. The evaluation of such approaches should focus on the development of imaginative, locally relevant approaches to the management of patients rather than individual or practice referral rates.

Original languageEnglish
Pages (from-to)449-462
Number of pages14
JournalEducation for Primary Care
Volume14
Issue number4
Publication statusPublished - Nov 2003

Keywords

  • Audit
  • Continuing medical education
  • Continuing professional development
  • Practice-based education
  • Teaching methods

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