Email updates

Keep up to date with the latest news and content from BMC Family Practice and BioMed Central.

Open Access Research article

Referring patients to specialists: A structured vignette survey of Australian and British GPs

Moyez Jiwa1*, Michael Gordon2, Hayley Arnet1, Hooi Ee3, Max Bulsara4 and Brigitte Colwell5

Author Affiliations

1 Western Australian Centre for Cancer and Palliative Care, Curtin University of Technology, Perth Western Australia, Australia

2 Gleadless Medical Centre, Gleadless, Sheffield, UK

3 Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

4 University of Western Australia, Perth, Western Australia, Australia

5 University of Sheffield, Sheffield, UK

For all author emails, please log on.

BMC Family Practice 2008, 9:2  doi:10.1186/1471-2296-9-2

Published: 15 January 2008



In Australia and in the United Kingdom (UK) access to specialists is sanctioned by General Practitioners (GPs). It is important to understand how practitioners determine which patients warrant referral.


A self-administered structured vignette postal survey of General Practitioners in Western Australia and the United Kingdom. Sixty-four vignettes describing patients with colorectal symptoms were constructed encompassing six clinical details. Nine vignettes, chosen at random, were presented to each individual. Respondents were asked if they would refer the patient to a specialist and how urgently. Logistic regression and parametric tests were used to analyse the data


We received 260 completed questionnaires. 58% of 'cancer vignettes' were selected for 'urgent' referral. 1632/2367 or 69% of all vignettes were selected for referral. After adjusting for clustering the model suggests that 38.4% of the variability is explained by all the clinical variables as well as the age and experience of the respondents. 1012 or 42.8 % of vignettes were referred 'urgently'. After adjusting for clustering the data suggests that 31.3 % of the variability is explained by the model. The age of the respondents, the location of the practice and all the clinical variables were significant in the decision to refer urgently.


GPs' referral decisions for patients with lower bowel symptoms are similar in the two countries. We question the wisdom of streaming referrals from primary care without a strong evidence base and an effective intervention for implementing guidelines. We conclude that implementation must take into account the profile of patients but also the characteristics of GPs and referral policies.