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The analysis revealed a number of factors constraining the use of information in general practice. First, the communication gap between primary and secondary care needs to be addressed. Sometimes GPs are unaware of their patients’ recent tests, scans and medication changes as their hospital colleagues often omit to include these findings in reports to practices. In addition, when these documents do arrive, they are often poor containing ambiguous or inadequate information to make clinical decisions, or arrive too late, when decisions have already been made. Specifically, respondents said that A&E reports are usually received within 3 days, whereas discharge summaries and outpatient letters often take up to 3 weeks to arrive. This is particularly problematic for patients who visit their GP soon after their discharge from hospital. Participants felt that would be useful to have this information electronically shared in real time, but the minimal IT integration between hospital and general practice systems hinders effective information sharing in care pathways and increases the risk of medical error in general practice (Box 3).
GPs’ perceptions on the barriers to the effective use of information
GP02
When hospitals send them [A&E and discharge summaries) through we have all the information, although sometimes you do not get those through.
GP03
The home system is integrating with nothing. The only thing that automatically populates is blood results, but we are the ones that have ordered them, not the hospitals. The fundamental thing would be that the hospital doctors next door each time they saw a patient, they would just log on, call in the patient, look at the system, all that I can see they can see, put their bits and pieces like what they have seen or what they have found, any test results would also come back, so that there would be one continuous moving record. That’s the ultimate.
GP04
If you have got a diabetic patient, where you wonder what his controls are like, with data, to see if he is being well controlled, and you send off a blood test, to check his sugars, and he says oh, I had that done at the hospital, but the letter from the consultant says he is doing very well and he is fine, but there is no data, they don’t write down the number.
GP07
Written discharge summaries are usually pretty terrible, very variable quality of information. What we really need is good and timely data.
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