Teleconference as an alternative to written advice and guidance referrals at the medical primary-secondary care interface.

Background: Communication issues across the primary and secondary care systems are considered the third most important unanswered research question in improving patient safety in the UK. Teleconferencing offers a potential means of improving the referral process but is largely unevaluated.

Objective: To examine stakeholder perspectives on use of teleconference as an alternative to Advice and Guidance (A&G) referrals for neurology cases.

Methods: A qualitative study was carried out in a primary care network (PCN) and a secondary care centre in Cambridgeshire. 18 clinicians (including nine GPs; seven hospital consultants) and 10 other stakeholders were interviewed. Observations of teleconference meetings and a focus group with five PCN staff provided additional data. Data collection and analysis were guided by the Consolidated Framework for Implementation Research, and Reflexive Thematic Analysis informed the analytical approach.

Results: Advantages of teleconferencing identified by participants included greater clinician satisfaction, educational value, streamlined patient journeys and continuity of care. Perceived issues included informational governance, time constraints and funding. Teleconferences were also seen to build relationships between GPs and specialists and to reduce unnecessary outpatient referrals. However, there were concerns of this being used potentially as a gateway for all referrals. Overall, participants welcomed the teleconference approach but questioned its cost-effectiveness and replicability in other settings.

Conclusions: Teleconferences could be a promising alternative to A&G referrals and appear to help build relationships between GPs and hospital neurologists. However, further studies are needed to assess their effectiveness as well as cost-effectiveness and guide future development and implementation.