Table 5 Reported facilitators and barriers of primary care streaming
Type of Service in ED | Facilitators | Quote |
|---|---|---|
Separate primary care service | The ability to stream children to a GP | “Since the Urgent Care centre (UCC) opened up, we saw a 50% reduction in children being seen in the ED, because they were being streamed to the UCC rather than us”. (Hospital 7) |
Streaming guidance and support | “We’ve developed our own guidelines, I mean based on the facility itself, as to who should go where. Because all the staff - apart from the GPs who are in the Urgent Care centre - are our staff, it kind of works, because people will speak to each other as well, and ask where they think someone is appropriate for”. (Hospital 10) | |
Senior clinician monitoring of streaming | “Sometimes the doctor in charge will have a look through the box and notice, on reviewing the triage notes, will think ‘actually, that sounds very suitable for primary care’, and sometimes the primary care physician themselves will have a look through the box because they will not have anyone to see, and so they’ll identify ones that they can see”. (Hospital 4) | |
Barriers | Quote | |
Lack of shared governance and poorly established working relationships | “so there wasn’t a team of doctors that owned the GP service, and we didn’t get to know them, and they didn’t get to know us, and so there are points of tension where the streaming nurses have sent patients across and they’ve been sent back,” (Hospital 18). | |
Lack of shared governance- reduces collaboration | “My impression was that the company who owns the service would only allow the GP to see a restricted range of patients because of Governance”. (hospital 7) | |
Insufficient primary care demand | “We tried using Luton streaming model, but using Luton streaming model we ended up with less than 2 patients an hour going to them”. (Hospital 19) | |
Integrated emergency medicine service | Facilitators | Quote |
Shared clinical governance encourages collaboration and enables flexibility in which patients GPs can see | “Because we all work in one hub essentially and we’re all under one governance hat, a GP can flip streams if there’s something appropriate in the stream next door”. (Hospital 3) |