The consultants’ role in the referring process with general practitioners: partners or adjudicators? a qualitative study

BACKGROUND Within the health system, communication between the different levels of care is essential for the patients' clinical pathways and medical treatment. This includes the referral process: how and why patients are sent from the primary care level to specialist health services. We wanted to identify and describe hospital consultants' reflections on and attitudes to the referral process and cooperation with general practitioners (GPs). METHODS A qualitative study of semi-structured interviews with 13 hospital consultants representing eight different specialties, analyzed using systematic text condensation. Interviews conducted from February 2011 to October 2012. RESULTS The consultants reported a considerable workload assessing referrals from GPs and prioritizing patients for specialist services. National guidelines were used as well as individual standards and guidelines. Good referrals could make the prioritization process easier. The specialists expressed a deep concern about securing a fair priority of patients and a willingness to give reasonable advice back to the referring GP when rejecting a referral. Better communication, such as a telephone call to confer with a hospital specialist before referral, was wanted. CONCLUSIONS Better communication and cooperation between hospital consultants and GPs could make the referral process more balanced, and the participants more like partners.