How does a GP decide to refer to a mental health specialist?

Evans-Jones, Josephine Helen (2001). How does a GP decide to refer to a mental health specialist? PhD thesis The Open University.



The study''s research into a GP''s referral decision making to a mental health therapist was instigated by audits which showed a difference in the numbers of referrals made by individual GPs to a Counsellor and a Clinical Psychologist working in a GP surgery. It was discovered that variations between the individual GPs'' referral numbers was also present in an audit of a second practice with the same services but with different therapists.

A qualitative study using semi-structured interviews, which included each GP''s presentation of their latest referrals to a Counsellor, Clinical Psychologist and Psychiatrist, was carried out with a structured sample of 12 GPs who had different referral profiles. Three different styles of analysis were used on the data. A Case Study approach analysed descriptions of individual GPs'' referral processes. A Cross-Case analysis identified some of the concepts that could affect a variation in referral numbers by different GPs. An Interpretative Phenomenological Analysis (I.P.A.) looked at some of the shared conceptual and contextual beliefs underlying a GP''s referral decision making. Finally, a synthesis of the analyses generated a map of the process of the GPs'' referral decision making.

The findings suggest that when making a referral to a mental health therapist each GP will endeavour to negotiate a "fit" between each patient and a therapist, that in the GP''s estimation will best help the individual patient with their mental health problem. These negotiations are shaped by the GPs'' beliefs in their role and function and influenced by themes of individuality and gender. It also suggested that these processes are characteristic of primary care where each doctor and patient relationship is unique.

This study has implications for GP training, GP education, the provision of mental health services to primary care and decision making theories, both medical and general.

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