Background
Methods
Testing result communication: Knowledge evaluation and development study (TRaCKED)
Settings and participants
Focus groups
Analysis
Ethics, consent and permissions
Results
Practice Characteristics | Practice 1 | Practice 2 | Practice 3 | Practice 4 |
---|---|---|---|---|
Number of GPs (fte)a | 7.3 | 3.0 | 6.3 | 12.3 |
IMD Rankingb | 15,066 | 13,866 | 871 | 7127 |
Number of patients | 23,727 | 8447 | 7059 | 27,430 |
Practice | Number of words (% of total) | |
---|---|---|
Focus Group 1 (FG1) | ||
Practice Manager (PM-1) | Practice 1 | 4121 (40%) |
Patient (Pt1–1) | Practice 1 | 1239 (12.0%) |
IT Lead (IT-1) | Practice 1 | 1156 (11.2%) |
Patient (Pt-4) | Practice 4 | 1020 (10.0%) |
Lead Receptionist (LR-1) | Practice 1 | 908 (8.8%) |
Lead Receptionist (LR-2) | Practice 2 | 399 (3.9%) |
Practice secretary (PS-2) | Practice 2 | 361 (3.5%) |
Phlebotomist (Pbt-3) | Practice 3 | 537 (5.0%) |
Patient (Pt-2) | Practice 2 | 405 (4.0%) |
Patient (Pt −3) | Practice 3 | 161 (1.6%) |
Total Word Count FG1 | 10,370 (100%) | |
Focus Group 2 (FG2) | ||
Office Manager (OM-3) | Practice 3 | 2959 (33.3%) |
Research Nurse (Res Nrs-3) | Practice 3 | 2261 (25.4%) |
Patient (Pt-4) | Practice 4 | 1666 (18.8%) |
Patient (Pt2–1) | Practice 1 | 1156 (13.0%) |
Patient (Pt3–1) | Practice 1 | 840 (9.5%) |
Total Word Count FG2 | 8882 (100%) |
Word counts and sociogrammatical analysis
Thematic analysis
Theme |
Focus Group 1
| Focus Group 2 |
---|---|---|
Social context |
Status
|
Associational
|
Alliances amongst focus group members |
Between staff
|
Between staff and patients
|
Assumption of role within the group |
Fixed role assumption
|
Fluid role assumption
|
Social context
Status
Moderator (Mod): Until your sample is taken, or the patient’s sample is taken, is there an appropriate amount of time?Lead receptionist, practice one (LR-1): We normally ask patients to ri…Practice manager, practice one (PM-1): ask them to ring back after a week
Mod: So how and what would you like to do differently?Phlebotomist, practice three (Pbt-3): I’d like if they could have blood tests on the same day, save the patients coming backPM-1: …we’re not a bottomless pit, this is the NHS and in the ideal world wouldn’t it be great just ‘Oh yeah, take a seat over there’Pbt-3: Yeah, but with…PM-1: ‘We’ll take your blood’ you know…you’ve got to think that there’s immunisations going on, there’s dressings, daily people are having dressings, stitches out. The nurses aren’t, and health care assistants, aren’t just taking blood are they?Pbt-3: No, no.
Associational context
Office manager 3: I agree with informing patients.Patient, practice 4: Whatever system you have, there’s got to be a mistake proof method that encompasses all the means of communication; text, telephone, written… it’s all got to be mistake proof.Office manager 3: I think as you say, they should actually, almost, they should have a copy of their results. That would be the ideal way.Mod: Aim for zero errors.Research nurse, practice 3: But if you…used this cytology model for example if the consortiums are going out and saying to people ‘we’re buying in more services, we’re going to use your results service, and in two weeks we expect every patient who had this test done to be given ‘Your blood test is normal’ or ‘Your blood tests are abnormal, if abnormal, this is what we do’ you know, If you can do it, [for cytology] - I know cytology’s got a smaller group of people - but it’s already set up isn’t it?
Res Nrs-3: You can almost, actually when doctors go in and pick up the test results transferred from the labs, it would be very easy at that juncture to put in a standard letter, press the button for ‘standard letter’ and get it printed off, so…Patient, practice 2 (Pt-2): Or send a text, or whatever it is.Pt-4: Whatever the patient prefers.OM-3: Yeah, maybe look at it that way, yeah.Res Nrs-3: As long it’s … as long as the doctor doesn’t spend time looking for it, it has to be quite a fast system, because they are pushed for time they really … do have a lot to do of course … and we have to make it as easy as possible for it to be used correctly.
Alliances amongst focus group members
Between staff
LR-1: I mean sometimes if somebody did come up, you know ‘I need a blood test and I really need one today’ then we will ask the nurse.PM-1: Yeah, yeah.LR-1: Then you know, it all depends on if the nurse has got time to do it or the health care assistant you know? On the whole at our practice, I mean if we did phone through and say ‘I need’ - you know – ‘I need you to do this’ they would do itPM-1: Yeah the doctor or the nurses.LR-1: Yeah, they are pretty good.PM-1: Yeah, they’re pretty good our nurses. They’re quite flexible really
Patient one, practice one: I mean, they take a lot of flack, the receptionists. I mean, they do. For things that they can’tPM-1: YeahPt1-1: Alright you get the snotty ones, you know, I’m not saying who.PM-1: I mean, we’re quite lucky with our patients, really, in that the majority are really good. But you do always remember the horrible ones. There’s no doubt about it, you know. You think ‘Oh God.’ But er, on the wholeLead receptionist, practice two (LR-2): And some people just go through life being angry don’t they?
Between staff and patients
Res Nrs-3: but people will find a way round the system, so once they know the system, they’re smart enough to … work it out. Because they want to be seen they want the answer. I’ve done it I must admit when my daughter was younger and I wanted to book a session in case they weren’t able to give me an appointment later.Patient, practice three (Pt-3): This is what frustrates me about the health service especially something like the NHS which is free at the point of care. Why do you need to know the system inside and out to use, to take advantage of it? Why is it not the same for everyone? It’s frustrating.
Assumption of role within the group
Fixed role assumption
PM-1: First of all most of them are going to come back anyway aren’t they? Second of all most patients will phone up or come in or ask, and the doctors are aware of the ones where there is an issue you know? Be it dementia, be it what…you know, learning difficulties whatever, so that’s the sort of third thing, and if it’s really serious the labs are phoning you up! Seems to me there are quite a lot of safety nets there.
Fluid role assumption
Pt-2: You go back to childhood in some way, especially when I get into hospitalOM-3: I mean I agree with what that gentleman said; to a certain extent it’s down to the patient; I work at a surgery so, you know, often I’m giving out results, but when I go to my own surgery as a patient I become this little girl who’s sort of. It’s true, you revert don’t you? I think, ‘well he must know what he’s doing so I’ll just wait for him to get back to me’.
Res Nrs-3: The important thing is not the result but how you feel?Several: Yeah.Res Nrs-3: If you get a good result you think ‘well that’s it I can’t go back again because I’m normal’ and that is so, I feel, dangerous to the patient, because they should go back again; they should ask again.