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Interpretations of referral appropriateness by senior health managers in five PCT areas in England : a qualitative investigation

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Blundell, N., Clarke, Aileen, 1955- and Mays, Nicholas. (2010) Interpretations of referral appropriateness by senior health managers in five PCT areas in England : a qualitative investigation. Quality and Safety in Health Care, Vol.19 (No.3). pp. 182-186. ISSN 0143-005X

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Official URL: http://dx.doi.org/10.1136/qshc.2007.025684

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.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General)
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Medical care -- Great Britain, Medical referral -- Great Britain, Surgery -- Great Britain
Journal or Publication Title:	Quality and Safety in Health Care
Publisher:	BMJ Group
ISSN:	0143-005X
Date:	June 2010
Volume:	Vol.19
Number:	No.3
Page Range:	pp. 182-186
Identification Number:	10.1136/qshc.2007.025684
Status:	Peer Reviewed
Access rights to Published version:	Open Access
Funder:	National Institute for Health Research (Great Britain) (NIHR)
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URI:	http://wrap.warwick.ac.uk/id/eprint/3889