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GPs go forth

Women's rate of hospital referrals out of hours much higher than men's

Gender a factor in wide admission variation

By Katherine Haywood

Women GPs working out of hours are far more likely to refer patients to hospital than male GPs, a study has revealed.

GP emergency referrals were five times higher in the top quartile than those in the bottom quartile. The variations could not be explained by experience of the GPs, the volume of patients or particularities of a practice.

But the study, published in February's British Journal of General Practice, found that the sex of the GP had an important

impact on referral rate, with women GPs referring 11.2 per cent of patients out-of-hours and men 8.6 per cent. The time and place of contact also had an effect.

Patients were most likely to be referred if seen between 11pm and 7am, when 12.2 per cent were sent to hospital.

Only 10.5 per cent of patients between 7pm and 11pm and 8 per cent of patients between 7am and 7pm on non-weekdays were referred. The referral rate was higher for home visits.

Follow-up investigation suggested GPs were more likely to refer to hospital if they had a positive view of that hospital or were fearful of litigation.

Dr Michael Rossdale, a Bristol GP and one of the study

authors, said: 'The only predictors found to have an independent association with referral rates were the sex of the clinician and the time and place of the consultation.

'It shows policymakers can effect amazing changes in services, such as introducing

urgent care centres, but what matters more than anything is what doctors you employ. It

suggests that we need interventions that make the decision-making of GPs more consistent,' he added.

Dr Fay Wilson, a GPC member who has analysed out-of-hours referral rates of Birmingham co-operative BADGER, said the referral rates were higher than her findings.

'Our investigations have not found a gender variation and I'm not sure it would stand up to scrutiny,' she said. 'We have found that the biggest variation is explained by the type of patients the doctor has.'

Dr Wilson added: 'We have also found that differences

depend on shifts. For example, Saturday morning has a lower referral rate than Saturday night.'

Dr Mark Reynolds, chair of the National Association of GP Co-operatives, said: 'The implication that doctors are revving it up after hours is extraordinary. Doctors are less likely to refer patients to hospital than other services at any time.'

The study looked at out-of-hours contacts of 149 GPs working for North Bristol Out-of-Hours Co-operative between 2001 and 2004.

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