Table 2

Results of questionnaire pilot

ResponseNumber of countries in which piloting PCPs agreed with statementNumber of countries in which piloting PCPs were unsureNumber of countries in which piloting PCPs disagreed with statement
Even if there are no ‘red-flag’ symptoms, we usually refer if we have a feeling that something is wrong.*1140
Here, high-quality care for an individual patient is always more important than costs.565
If we have ‘over-referred’, our own income may be reduced.*1312
If we organise any investigations, we pay for that themselves.*1213
In some practices, patients often have to travel a long way to see a specialist.952
Long waiting lists for specialists or tests mean that we sometimes delay a referral/special investigation until it is really necessary.*1105
Many primary care doctors have special investigations (eg, diagnostic ultrasound) in their practices.*1510
Missing a diagnosis of cancer is something that we particularly worry about.*1500
Patients can self-refer to specialists, so we do not need to act as a gatekeeper.5110
Patients sometimes criticise us if they think we delayed a cancer diagnosis because of a late referral.*1330
Paying for a specialist can be a problem for some of our patients.547
Referral costs are usually paid by insurance companies, not primary care or hospital budgets.637
Referring or not referring does not affect our income at all.1033
Some of our referral systems (eg, online referral systems) make the referral process more difficult.*1411
Specialists often try to reduce referrals to them.*1510
Specialists often welcome referrals.673
Specialists sometimes criticise us if they think that a cancer diagnosis was slow because of a late referral.*1231
Specialists sometimes criticise us if they think that we should have been able to look after the patient ourselves.754
There is a special, quick specialist appointment system for patients with suspected cancer.835
Usually, patients prefer a general practitioner (rather than a specialist) to look after them.664
We are asked not to refer patients with a low risk of cancer.*1411
We are asked to refer any patients with possible cancer early, even if there is a low risk of cancer.673
We are likely to refer if the patient is very worried that he/she has cancer, even if there are no ‘red flag’ symptoms.*1221
We are likely to refer if the patient says that she/he would like to be referred, even if there are no red flags.834
We are often worried about the risk of unnecessary (and possibly harmful) investigations.*1221
We are under media (newspaper, television) or public pressure to refer earlier.546
We are under media (newspaper, television) or public pressure to refer less.*1311
We are usually very busy, so we sometimes refer to help reduce our workload.655
We can easily email a specialist for advice.538
We can easily telephone a specialist for advice.556
We can refer directly to a named specialist.844
We have a budget for patient care costs, but we share it with secondary care.*0214
We have a budget or quota (maximum limit) for referrals.*1312
We have a budget or quota (maximum limit) for special tests.429
We have guidelines that help us decide which patients to refer.727
We often refer to a specialist that we know personally.862
We usually have enough time in the consultation to think carefully about whether the patient needs a referral.664
We worry about the possibility of legal action or a formal complaint if we refer late.*871
Writing a good referral letter takes time, and as we are usually very busy we sometimes delay making a referral.*1213
  • *These statements were removed from the final questionnaire because either (a) one or no piloting countries agreed with the statement, or (b) one or no piloting countries disagreed with the statement.