Health system items and their factor analysis loadings The highest-scoring component for each item is italicised.
| Health system item | Component | ||||
| Factor 1 | 1 | 2 | 3 | 4 | 5 |
| I am able to refer to a specialist that I know personally. | 0.68 | 0.42 | 0.09 | 0.03 | −0.14 |
| Here, specialists usually welcome referrals. | 0.68 | 0.02 | 0.12 | −0.04 | −0.11 |
| I can easily telephone (or email) a specialist for informal discussion and advice. | 0.68 | −0.12 | 0.11 | 0.17 | −0.12 |
| I am able to refer directly to a named specialist. | 0.62 | 0.22 | 0.22 | 0.13 | −0.26 |
| I usually have enough time in the consultation to think carefully about whether the patient needs a referral. | 0.57 | −0.02 | −0.32 | 0.07 | 0.12 |
| My colleagues sometimes criticise me if I have referred a patient to them, but they think that I should have been able to manage the patient myself. | −0.51 | 0.25 | 0.14 | 0.12 | 0.31 |
| Factor 2 | |||||
| Seeing a specialist can be a problem for some of my patients because of the financial cost to them. | −0.08 | 0.59 | −0.17 | 0.27 | 0.24 |
| We have access to a fast-track specialist appointment system for patients with suspected cancer. | 0.05 | −0.54 | 0.34 | 0.34 | −0.03 |
| We have a budget or quota (maximum limit) for diagnostic tests. | −0.27 | 0.54 | −0.06 | 0.25 | −0.26 |
| Referral costs are usually paid by insurance companies, not hospital or primary care budgets. | 0.30 | 0.46 | −0.05 | −0.19 | 0.23 |
| Patients can self-refer to specialists, so GPs do not need to act as gatekeepers. | 0.34 | 0.44 | 0.04 | −0.30 | 0.11 |
| In my practice, patients often have to travel a long way to see a specialist. | −0.26 | 0.38 | −0.09 | 0.37 | 0.36 |
| Factor 3 | |||||
| I am usually very busy, so I sometimes refer to help reduce my workload. | −0.32 | 0.19 | 0.60 | −0.09 | −0.01 |
| I am likely to refer if the patient says that she/he would like to be referred, even if there are no ‘red flags’. | −0.02 | 0.29 | 0.53 | −0.34 | 0.16 |
| We are under media (newspaper, television) or public pressure to refer earlier. | −0.20 | 0.08 | 0.51 | −0.09 | −0.16 |
| The local health system encourages us to refer any patients with possible cancer early, even if there is a low risk of cancer. | 0.26 | 0.11 | 0.36 | 0.23 | 0.20 |
| Factor 4 | |||||
| Common presentations are covered by local or national guidelines that usually give advice on which patients to refer | 0.05 | −0.25 | 0.33 | 0.55 | 0.15 |
| In general, patients prefer a GP, rather than a specialist, to look after them. | 0.25 | 0.19 | −0.02 | 0.41 | 0.08 |
| Factor 5 | |||||
| Here, high-quality care for an individual patient is always more important than costs. | 0.30 | −0.26 | 0.01 | 0.05 | 0.57 |
| Referring or not referring does not affect me at all financially. | 0.31 | −0.29 | 0.08 | −0.34 | 0.55 |