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

Background Emergency admissions to hospital at night and weekends are distressing for patients and disruptive for hospitals. Many of these admissions result from referrals from GP out-of-hours (OOH) providers. Aim To compare rates of referral to hospital for doctors working OOH before and after the new general medical services contract was introduced in Bristol in 2005; to explore the attitudes of GPs to referral to hospital OOH; and to develop an understanding of the factors that influence GPs when they refer patients to hospital. Design of study Cross-sectional comparison of admission rates; postal survey. Setting Three OOH providers in south-west England. Method Referral rates were compared for 234 GPs working OOH, and questionnaires explored their attitudes to risk. Results There was no change in referral rates after the change in contract or in the greater than fourfold variation between those with the lowest and highest referral rates found previously. Female GPs made fewer home visits and had a higher referral rate for patients seen at home. One-hundred and fifty GPs responded to the survey. Logistic regression of three combined survey risk items, sex, and place of visit showed that GPs with low 'tolerance of risk' scores were more likely to be high referrers to hospital (P<0.001). Conclusion GPs' threshold of risk is important for explaining variations in referral to hospital.