REASONS FOR VARIATIONS IN THE USE OF OPEN ACCESS GASTROSCOPY BY GENERAL-PRACTITIONERS

This study aimed to investigate the wide variation between general pra ctitioners (GPs) in their use of open access gastroscopy by assessing (i) their partnership share, workload, and the aggregated practice req uest rate; (ii) correlations with their professional and practice char acteristics; and (iii) a comparison with referral rates to medicine, s urgery, and all specialities. All 145 GPs and their practice managers were sent a questionnaire and hospital held data on all requests for o pen access gastroscopy over one year were reviewed. During the year, t he 145 GPs made 1210 requests for open access gastroscopy, varying fro m one to 44 per GP. There were 987 880 practice consultations altogeth er, an average of 22 451 per practice or 7127 per whole time practitio ner. Requests for open access gastroscopy formed 2.4% of all referrals , an average of one per 1000 consultations, or eight per GP. Of a tota l of 49 123 referrals to all specialities (371 per GP) 4218 (8.5%) wer e to medicine, and 6444 to surgery (13.1%). The following factors did not correlate with requests: vocational training, a concurrent hospita l post, length of service, or receipt of the deprivation allowance by the practice. When the open access gastroscopy referral rate was aggre gated for each practice the variation between practices was narrowed t o essentially twofold. Requests for open access gastroscopy form a sma ll proportion of all referrals (2.4%). Aggregated practice request rat es are relatively uniform compared with the wide variation between ind ividual GPs, portionate gastroenterology between partners. The open ac cess gastroscopy service does not seem to be subject to misuse from mo st GPs if a variation in practice usage is used as a measure.