Article Text

Download PDFPDF
Cross-sectional analysis of hospital tasks handed over to general practitioners: workload delegation or dumping?
  1. Zahir Mughal,
  2. Rajib Maharjan
  1. Department of General Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
  1. Correspondence to Dr Zahir Mughal, Department of General Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK; zahir5019{at}gmail.com

Abstract

Purpose of the study New requirements for hospital clinicians to follow up and act on hospital-initiated investigations were introduced in 2016 in the National Health Service standard contract. We aimed to evaluate the tasks handed over from hospital clinicians to general practitioners (GPs).

Study design A retrospective observation of all tasks in a random sample of electronic discharge summaries at a university teaching hospital over a 1 month period was conducted. A single-best-answer questionnaire was circulated among hospital clinicians over 3 months to gain an understanding of their follow-up and referral practices.

Results The total number of tasks found on discharge summaries (n=178) were 227, of which 39% were directed at GPs and 61% at the hospital team. Of 89 tasks delegated to GPs, 33% were inappropriate. Some tasks on discharge summaries were delegated more frequently to GPs such as blood tests (73%) and endoscopy requests (67%). While others were undertaken more often by hospitals clinicians including imaging requests (88%), follow-up appointments (87%) and onward referrals (71%). Surveyed doctors (n=72) admitted to asking GPs to follow up blood tests (52%), imaging and endoscopy (16%) and make onward referrals for related conditions (14%) and unrelated conditions (70%).

Conclusion The majority of outstanding tasks in the hospital setting were followed up by hospital clinicians. A considerable volume of tasks were delegated to GPs, of which a significant proportion were inappropriate. An increase in awareness and understanding among hospital clinicians of their responsibility to follow up hospital-initiated investigations is needed.

  • primary care
  • clinical governance
  • organisational development
  • risk management

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

Statistics from Altmetric.com

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

View Full Text

Footnotes

  • Contributors ZM conceived the study, designed the study, analysed the hospital record data and the questionnaire data, drafted the article and is responsible for the overall content as guarantor. RM conceived the study, collected the questionnaire data and edited the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.