The disappearance of the "revolving door" patient in Scottish general practice: successful policies

Williamson, A.E., Johnson, P.C.D. , Mullen, K. and Wilson, P. (2012) The disappearance of the "revolving door" patient in Scottish general practice: successful policies. BMC Family Practice, 13(1), p. 95. (doi:10.1186/1471-2296-13-95)

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Abstract

Background We describe the health of "revolving door" patients in general practice in Scotland, estimate changes in their number over the timescale of the study, and explore reasons for changes, particularly related to NHS and government policy.

Methods A mixed methods predominantly qualitative study, using a grounded theory approach, set in Scottish general practice. Semi-structured interviews were conducted with professional key informants, 6 Practitioner Services staff who administer the GP registration system and 6 GPs with managerial or clinical experience of working with "revolving door" patients. Descriptive statistical analysis and qualitative analysis of patient removal episodes linked with routine hospital admissions, outpatient appointments, drug misuse treatment episodes and deaths were carried out with cohorts of "revolving door" patients identified from 1999 to 2005 in Scotland.

Results A "revolving door" patient is removed 4 or more times from GP lists in 7 years. Patients had complex health issues including substance misuse, psychiatric and physical health problems and were at high risk of dying. There was a dramatic reduction in the number of "revolving door" patients during the course of the study.

Conclusions "Revolving door" patients in general practice had significant health problems. Their numbers have reduced dramatically since 2004 and this probably resulted from improved drug treatment services, pressure from professional bodies to reduce patient removals and the positive ethical regulatory and financial climate of the 2004 GMS GP contract. This is a positive development for the NHS.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Williamson, Dr Andrea and Mullen, Dr Kenneth and Johnson, Dr Paul and Wilson, Dr Philip
Authors: Williamson, A.E., Johnson, P.C.D., Mullen, K., and Wilson, P.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:BMC Family Practice
ISSN:1471-2296
ISSN (Online):1471-2296
Published Online:04 October 2012
Copyright Holders:Copyright © 2012 The Authors
First Published:First published in BMC Family Practice 13(1):95
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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