What’s the weakest link in the chain of care?

#GPFUQ 193 What’s the weakest link in the chain of care? Attempts to reduce emergency hospital admissions should focus on all the people (patients, their carers and clinicians) at high risk. If better care is available outside of hospitals the rising demand for the care of patients with chronic conditions is hard to understand. It’s the weakest link in a chain of people at risk that’s important. The links are weak and the risk of emergency admission high when patients, their carers and clinicians each has to struggle to cope with a mix of complex medical and social conditions, the plethora of services available, perverse guidelines and incentives that confuse best practice, and the lack of effective feedback loops to inform their choices about care. The weakest link can be anywhere in the chain of people and services.

For example one of the many factors in the mix is the GP. A series of studies of GP Out of hours services in Bristol (Reference 1) showed a marked (a four fold) variation in emergency referrals between the top and bottom quartiles of referrers and a ten fold difference between the top ten and the bottom ten referrers. A low `tolerance of risk' by the GP seemed to be the weak link that predicts emergency referrals. Strengthening this weak link and each weak link in the chain by making the differences in behaviour visible by better feedback to the patients, carers and clinicians might reduce variation in performance and improve quality. Better knowledge and understanding of risk needs to be shared with out patients when making decisions about their care. 

Reference

Risk taking in general practice: GP out-of-hours referrals to hospital

Authors: Ingram, Jenny; Calnan, Michael; Greenwood, Rosemary J; Kemple, Terry; Payne, Sarah; Rossdale, Michael