A new role for the general practitioner? Reframing ‘inappropriate attenders’ to inappropriate services

Chew-Graham, C, Rogers, A, May, C, Sheaf, R and Ball, E ORCID: https://orcid.org/0000-0002-4551-1416 2004, 'A new role for the general practitioner? Reframing ‘inappropriate attenders’ to inappropriate services' , Primary Health Care Research & Development, 5 , pp. 60-67.

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This qualitative study describes the impact of deploying general practitioners (GPs) as primary care physicians (PCPs) in three Accident and Emergency (A&E) departments in Greater Manchester as part of a Health Action Zone initiative to promote integration of systems of care more responsive to the needs of inner city population groups. The setting was three Accident and Emergency Units in Greater Manchester. Semi-structured interviews with the PCPs and key A & E staff (n = 32) before the PCPs were deployed, then at intervals throughout the project. Interviews were audiotaped and transcribed. Transcripts were analysed using constant comparison to identify emerging themes. Key themes centred on the assumptions and negotiation surrounding the emerging roles of the PCPs (as seen by themselves and other staff), particularly the conflict between operational (day-to-day work with patients) and strategic (forward planning) roles. The PCP appeared to act as a catalyst for the view that patients were not presenting “inappropriately”, rather, the problems presented at A&E might be best dealt with in different parts of the healthcare system, or by different personnel, and it is the service currently available that is inappropriate. By deploying the GP in a new role as PCP, but with the traditional autonomy associated with being a GP, and allowing him/her to develop the role according to local need, the new service evolved to identify and meet the needs of patients more appropriately. The use of the expanded role of the GP may be more successful in achieving ‘joined-up’ services than deploying other professional groups, such as nurses, to fulfil a specific role.

Item Type: Article
Themes: Subjects / Themes > R Medicine > R Medicine (General)
Health and Wellbeing
Schools: Schools > School of Health and Society
Journal or Publication Title: Primary Health Care Research & Development
Publisher: Cambridge University Press
Refereed: Yes
ISSN: 1463-4236
Depositing User: Dr Elaine Ball
Date Deposited: 22 Jul 2010 11:26
Last Modified: 16 Feb 2022 09:33
References: Armstrong, D., Granville, T., Bailey, E. and O’Keefe, G. 1990: Doctor-initiated consultations: a study of communication between general practitioners and patients about the need for re-attendance. British Journal of General Practice 40, 241–42. Calnan, M. 1983: Managing ‘minor’ disorders: pathways to a hospital accident and emergency department. Sociology of Health & Illness 5, 149–67. Carlisle, R., Groom, L.M., Avery, A.J., Boot, D. and Earwicker, A new role for the general practitioner 67 S. 1998: Relation of out of hours activity by general practice and accident and emergency services with deprivation in Nottingham: longitudinal study. British Medical Journal 316, 520–23. Cohen J. 1987: Accident and emergency services and general practice – con� ict or cooperation? Family Practice 4, 81–83. Dale J. 1992: Primary care: the old bugbear of accident and emergency services. British Journal of General Practice 42, 90–91. Department of Health. 2000: The NHS Plan : A plan for investment, a plan for reform. London: The Stationary Of� ce. Discroll, P.A., Vincent, C.A. and Wilkinson, M. 1987: The use of the accident and emergency department. Archives of Emergency Medicine 4, 77–82. Elston, S. and Holloway, I. 2001: The impact of recent primary care reforms in the UK on interprofessional working in primary care settings. Journal of Interprofessional Care 15, 20–25. Green, J. and Dale, J. 1992: Primary care in accident and emergency and general practice: a comparison. Social Science & Medicine 35, 987–1005. Hensher, M., Fulop, N., Coast, J. and Jefferys, E. 1999: The hospital of the future: better out than in? Alternatives to acute hospital care. British Medical Journal 319, 1127–30. Kunamaki, R. and Kokko, S. 1995: Reasons for consultation and explanations of illness among Finish primary-care led patients. Sociology of Health & Ilness 40, 231–43. May, C., Dowrick, C. and Richardson,M. 1996: The con� dential patient: the social construction of therapeutic relationships in general practice. Sociological Review 44, 187–203. McInerney, J., Chillala, S. , Read, C., Evans, A., Lawson, G.R., Furness, C., Santosh, S. and Armstrong, S. 2000: Impact of NHS Direct on demand for immediate care. British Medical Journal 321, 1077. McKee, C.M., Gleadhill, D.N.S. and Watson, J.D. 1990: Acci- Primary Health Care Research and Development 2004; 5: 60–67 dent and emergency attendance rates: variation among patients from different general practices. British Journal of General Practice 40, 150–53. Murphy, A.W. 1998a: ‘Inappropriate’ attenders at accident and emergency departments I: de� nition, incidence and reasons for attendance. Family Practice 15, 23–32. Murphy, A.W. 1998b: ‘Inappropriate’ attenders at accident and emergency departments II: health services responses. Family Practice 15, 33–37. Murphy, A.W., Plunkett, P.K., Bury, G., Leonard, C., Walsh, J., Lynam, F. and Johnson, Z. 2000: Effect of seeing a general practitioner in accident and emergency on their subsequent reattendance: cohort study. British Medical Journal 320, 903–04. Powell, M. and Moon, G. 2001: Health Action Zones: the ‘thirdway’ of a new area based policy. Health and Social Care in the Community 9(1), 43–50. Rajpar, S.F., Smith, M.A. and Cooke, M.W. 2000: Study of choice between accident and emergency departments and general practice centres for primary care problems. Journal of Accident and Emergency Medicine 17, 18–21. Reilly, P.M. 1981: Primary care and accident and emergency departments in an urban area. Journal of the Royal College of general practitioners 31, 223–30. Rogers, A., Hassell, K. and Nicolaas, G. 1998: Demanding patients? Analysing the use of primary care. Buckingham: Open University Press. Strauss, A. 1986: Qualitative analysis for social scientists. Cambridge: Cambridge University Press. Surender, R. and Fizpatrick, R. 1999: Will doctors manage? Lessons from general practice fundholding. Policy and Politics 27(4), 491–502.
URI: https://usir.salford.ac.uk/id/eprint/9491

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