A survey of General Practitioners' preferences, when referring to mental health services, and the implications for electronic-outpatient booking
Harvey, N. S.
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Electronic outpatient booking is to be introduced in England by 31st December, 2005, as a government initiative to speed up access to secondary care. For psychiatry, general practitioners (GPs) will be able to send referrals electronically to a multi-disciplinary allocation meeting that provides outpatient appointments, re-routes referrals and offers advice. The referrals may be sent during patient consultations, and the date of the multidisciplinary meeting given to patients, along with details for ascertaining the outcome within 24 hours and, if agreed, making an outpatient appointment at a convenient time. At present, there is little information on how GPs choose from a growing number of alternatives to outpatient referral. We have used a questionnaire to assess GPs' preferences in prioritising and referring patients to a variety of services that operate in conjunction with psychiatry. The questionnaire was sent to 114 sector GPs in Sheffield. 107 (94%) responded. GP referral letters were then assessed for a year, and the questionnaire re-sent to determine test-re-test reliability. Eighty-two GPs (72%) responded to the second questionnaire. GPs reported referring to community psychiatric nurses (CPNs) "moderately often," (level 3 on a 4-point scale) and to psychiatrists only "occasionally" (level 2). Paranoid schizophrenia and depressive illness received medium priority, ie. would be seen within 3 days, compared with 24 hours for problems including physical violence within the family. Urgency of confused and suicidal patients was judged inconsistently, as was who should manage weight loss, nonorganic physical complaints, an anxiety attack, disclosure of sexual abuse, and physical violence in the family. GPs producing high quality psychiatric referral letters had graduated more recently (P < 0.0003) and referred more widely (P < 0.05) within the services available. Their tailored approach to patients' needs produced the most appropriate referrals, as judged by our multi-disciplinary allocation meeting. Such tailoring may be expected to benefit from updates on how services are evolving, and from information about alternative referral routes available across disciplines. This could potentially be provided by electronic booking systems, but those planned for England and Wales will not have the full range of psychiatric multi-agency referral pathways. Electronic booking has not been agreed in Scotland.