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People Processing: Towards a Typology of Selected General Practitioner Referral and Admission Practices in Care of Elderly People*

Published online by Cambridge University Press:  14 November 2008

Caroline Cantley
Affiliation:
Lecturer, Social Administration Department, University of Birmingham, PO Box 363, Birmingham.
David Hunter
Affiliation:
Director, Unit for the Study of the Elderly, Department of Community Medicine, University of Aberdeen, Medical Buildings, Foresterhill, Aberdeen.

Abstract

Service providers are able by virtue of the nature of their work to shape how services operate and to influence who receives them. Of the many occupational groups involved in delivering care to the elderly general practitioners perform a pivotal role. While the ‘gatekeeper’ function of GPs is widely acknowledged there is little understanding of how this is actually performed or of the criteria underpinning decisions in regard to referrals and admissions. Old people display a complex of presenting conditions both physical and social with which the GP has to contend. At the same time services do not operate in isolation but interact in many subtle and not so subtle ways. To illustrate these themes the paper identifies and explores a set of considerations that appear to influence a group of GPs' use of services when referring patients to the geriatric service and admitting them to local hospital beds under their control.

Type
Research Article
Copyright
Copyright © Cambridge University Press 1985

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References

NOTES

1 Adler, M. and Asquith, S. (eds). Discretion and Welfare. Heinemann, London, 1981.Google Scholar

2 Hedley, R. and Norman, A.Home Help: Key Issues in Service Provision. Centre for Policy on Ageing, London, 1982.Google Scholar

3 Hill, M. The policy-implementation distinction: a quest for rational control? In Barrett, S. and Fudge, C. (eds). Policy and Action. Methuen, London, 1981.Google Scholar

4 Marshall, M. and Boaden, N.Residential care: how can we make admission less haphazard? Modern Geriatrics, 8 (1978), 3033.Google Scholar

5 Spackman, A. The allocation of Part III places to the elderly. Mimeo prepared for DHSS, University of Southampton, 1981.Google Scholar

6 Mitchell, S. and Earwicker, J.Getting People Placed: The Allocation of Residential (Part III) Home Places in Hammersmith and Fulham. Research Project on the Needs of the Elderly, London Borough of Hammersmith and Fulham Social Services Department, London 1982.Google Scholar

7 James, L. ‘Geriatric ghettos’ in the making. General Practitioner. 17 11 (1978), 22.Google Scholar

8 Charlesworth, A. and Wilkin, D.Dependency Among Old People in Geriatric Wards, Psychogeriatric Wards and Residential Homes 1977–81. Research Report No. 6, Research Section, Psychogeriatric Unit, University Hospital of South Manchester, Mancester, 1982.Google Scholar

9 Lipsky, M.Street Level Bureaucracy. Russell Sage, New York, 1980.Google Scholar

10 Prottas, J. M.People Processing. Lexington Books, Mass., 1979.Google Scholar

11 Elmore, R. F.Backward mapping: implementation research and policy decisions. Political Science Quarterly, 94 (19791980), 601616.CrossRefGoogle Scholar

12 Wilkin, D., Durie, A. and Wade, G. General practitioners and the elderly. Paper presented at the British Society of Gerontology Annual Conference, Liverpool, September 1983.Google Scholar

13 Crombie, D. L.Social Class and Health Status: Inequality or Difference. Occasional Paper 25, The Royal College of General Practitioners, 1984.Google ScholarPubMed

14 Wilkin, D., Metcalfe, D. H. M., Hallam, L., Cooke, M. and Hodgkin, P. K.Area variations in the process of care in urban general practice. British Medical Journal, 289 (1984), 229232.CrossRefGoogle ScholarPubMed

15 Dalley, G. and Thompson, C. GPs as referral agents. Health Care UK 1985, CIPFA/IHSM/Policy Journals, London, 1985.Google Scholar

16 Hunter, D. J. and Cantley, C. Exploring service variations in the care of the elderly. A voyage into the interior. In Bromley, D. B. (ed.). Gerontology: Social and Behavioural Perspectives. Croom Helm, London, 1984.Google Scholar

17 Crombie, , op. cit.Google Scholar

19 Wilkin, et al. , op. cit. 1983.Google Scholar

20 Wilkin, D., Wade, G. and Durie, A. Characteristics of elderly people referred to specialist services. Paper presented at the British Society of Gerontology Annual Conference, Liverpool, September 1983.Google Scholar

21 Jefferys, M. and Sachs, H.Rethinking General Practice. Tavistock Publications, London, 1983.Google Scholar

22 Dowie, R.General Practitioners and consultants: a study of outpatient referrals. King Edward's Hospital Fund for London, London 1983.Google Scholar

23 The place names are fictitious.

24 Shaw, C. D.General practitoner hospitals: coming or going? British Medical Journal, 288 (1984), 1399.CrossRefGoogle ScholarPubMed

25 Whitehouse, A. and Pearce, V. R.The elderly in cottage-community hospitals in Devon. Concord, 24 (1983), 1721.Google Scholar

26 Grant, J. A.Contribution of general practitioner hospitals in Scotland. British Medical Journal, 288 (1984), 13661368.CrossRefGoogle ScholarPubMed

27 Young, K.Values in the policy process. Policy and Politics, 5 (1977), 12.CrossRefGoogle Scholar

28 Askham, J.Professionals' criteria for accepting people as patients. Social Science and Medicine, 16 (1982), 20832089.CrossRefGoogle ScholarPubMed