RMC | Key features | Interview number | Interviewee characteristics | Role in RMC |
---|---|---|---|---|
A | Functions: Clinical triage by GPs with additional expertise and allied health professionals; reviews referrals from 30 specialties; referrals either diverted to community service, returned to GP with advice or sent on to acute trust; manages patient bookings through 'choose and book' process; provides individual level advice and guidance to GPs, monthly referral reports and live access to referrals data; broader educational function Organisation: Provided by existing out-of-hours provider and software specialist; covers 3 CCGs, 95+ practices, 70 000 referrals; practices pay based on patient list size; operating 2010-present; patient booking originally provided out of area but now commissioned locally | A1 | GP with managerial responsibility, director of RMS provider organization | Set-up and running |
A2 | Manager, CCG | Commissioning | ||
A3 | 2 managers (joint interview), RMS provider | Set-up and running | ||
A4 | GP | User only | ||
A5 | GP | User only | ||
B | Functions: Clinical triage by GPs; referrals either diverted to community service, returned to GP with advice or sent on to acute trust; reviews referrals from selected specialties; manages appointments booking (not linked to 'choose and book'); collects data to inform commissioning; limited individual level feedback; educational sessions and newsletters Organisation: Provided by existing out-of-hours provider; covers 1 CCG, 70+ practices; funded by CCG - cost per letter triaged; operating 2010-present; began as purely administrative with later introduction of GP triaging | B1 | Manager, CCG | Running |
B2 | GP with managerial responsibilities | Commissioning/set-up | ||
B3 | GP with managerial responsibilities | Running and user | ||
B4 | GP with managerial responsibilities | Development, running and user | ||
B5 | GP with managerial responsibilities, also employed by RMS provider | Set-up and running, GP triager and user | ||
B6 | GP | User only | ||
C | Functions: No clinical triage by RMC staff; consultant triage commissioned from secondary care; following consultant triage referrals to selected specialties diverted to community service, returned to GP with advice or accepted by acute trust; non-clinical staff at RMC manage patient bookings through ‘choose and book’ and the process of sending referrals for selected specialties for consultant triage; collects data to inform commissioning; data reports at GP/practice level; internal peer review and educational sessions Organisation: Provided by existing educational services provider; covers 1 CCG, <20 practices; funded by CCG - unit cost per triaged and non-triaged referral; operating 2012-present; began as purely administrative with later introduction of consultant triage element | C1 | Manager, RMS provider organization | Set-up and running |
C2 | Manager, CCG | Commissioning and set-up | ||
C3 | GP with managerial responsibility | Set-up, running and user | ||
C4 | Practice Manager, also involved in management of RMS provider organisation | User, set-up and running | ||
D | Functions: Clinical triage by GPs and nurses under supervision; focus on changing referral behavior through feedback and education; no diversion of referrals, GP retains responsibility for referral destination; no management of patient bookings; collects rich data; provides individual level feedback on referrals, weekly ‘top-tips’, access to detailed referral data; broader educational function Organisation: Provided by CIC set up specifically to deliver RMS; covers one CCG, opt in required – 16/24 participated; operating 2010–2013 – contract not continued. | D1 | Manager, RMS provider | Set-up and running |
D2 | GP with managerial responsibility, CCG | Commissioning | ||
D3 | GP, also employed by RMS provider | GP triager and user |