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Sickness certification system in the United Kingdom: qualitative study of views of general practitioners in Scotland.

ABSTRACT: OBJECTIVES: To explore how general practitioners operate the sickness certification system, their views on the system, and suggestions for change. DESIGN: Qualitative focus group study consisting of 11 focus groups with 67 participants. SETTING: General practitioners in practices in Glasgow, Tayside, and Highland regions, Scotland. SAMPLE: Purposive sample of general practitioners, with further theoretical sampling of key informant general practitioners to examine emerging themes. RESULTS: General practitioners believed that the sickness certification system failed to address complex, chronic, or doubtful cases. They seemed to develop various operational strategies for its implementation. There appeared to be important deliberate misuse of the system by general practitioners, possibly related to conflicts about roles and incongruities in the system. The doctor-patient relationship was perceived to conflict with the current role of general practitioners in sickness certification. When making decisions about certification, the general practitioners considered a wide variety of factors. They experienced contradictory demands from other system stakeholders and felt blamed for failing to make impossible reconciliations. They clearly identified the difficulties of operating the system when there was no continuity of patient care. Many wished either to relinquish their gatekeeper role or to continue only with major changes. CONCLUSIONS: Policy makers need to recognise and accommodate the range and complexity of factors that influence the behaviour of general practitioners operating as gatekeepers to the sickness certification system, before making changes. Such changes are otherwise unlikely to result in improvement. Models other than the primary care gatekeeper model should be considered.

SUBMITTER: Hussey S

PROVIDER: S-EPMC314050 | biostudies-literature | 2004 Jan

REPOSITORIES: biostudies-literature

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Sickness certification system in the United Kingdom: qualitative study of views of general practitioners in Scotland.

Hussey Susan S Hoddinott Pat P Wilson Phil P Dowell Jon J Barbour Rosaline R

BMJ (Clinical research ed.) 20031222 7431

<h4>Objectives</h4>To explore how general practitioners operate the sickness certification system, their views on the system, and suggestions for change.<h4>Design</h4>Qualitative focus group study consisting of 11 focus groups with 67 participants.<h4>Setting</h4>General practitioners in practices in Glasgow, Tayside, and Highland regions, Scotland.<h4>Sample</h4>Purposive sample of general practitioners, with further theoretical sampling of key informant general practitioners to examine emergi ...[more]

PMID: 14691065

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Project description:The ever increasing volume of referrals from primary care to specialist services is putting considerable pressure on resource-constrained health services while effective communication across fragmented services remains a substantial challenge. Previous studies have suggested that electronic referrals (eReferral) can bear important benefits for cross-organisational processes and patient care management.We conducted 25 semi-structured interviews and 1 focus group with primary care providers to elucidate General Practitioners' (GPs) perspectives on information management processes in the patient pathway in NHSScotland, 1 focus group with members of the Scottish Electronic Patient Record programme and one interview with a senior architect of the Scottish Care Information national eReferral System (SCI Gateway). Using Normalisation Process Theory, we performed a qualitative analysis to elucidate GPs' perspectives on eReferral to identify the factors which they felt either facilitated or hindered referral processes.The majority of GPs interviewed felt that eReferral substantially streamlined communication processes, with the immediate transfer of referral documents and the availability of an electronic audit trail perceived as two substantial improvements over paper-based referrals. Most GPs felt that the SCI Gateway system was reasonably straightforward to use. Referral protocols and templates could be perceived as useful by some GPs while others considered them to be cumbersome at times.Our study suggests that the deployment and adoption of eReferral across the NHS in Scotland has been achieved by a combination of factors: (i) a policy context - including national mandatory targets for eReferral - which all NHS health-boards were bound to operationalise through their Local Delivery Plans and also (ii) the fact that primary care doctors considered that the overall benefits brought by the deployment of eReferral throughout the patient pathway significantly outweigh any potential disbenefits.

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Dataset Information

Sickness certification system in the United Kingdom: qualitative study of views of general practitioners in Scotland.

Publications

Sickness certification system in the United Kingdom: qualitative study of views of general practitioners in Scotland.

Similar Datasets

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