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Br J Gen Pract. 2018 May;68(670):e323-e332. doi: 10.3399/bjgp18X695813. Epub 2018 Apr 23.

Responsibility for follow-up during the diagnostic process in primary care: a secondary analysis of International Cancer Benchmarking Partnership data.

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Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Research Unit for General Practice, Aarhus University, Aarhus, Denmark.
Department of Clinical Sciences, Lund University, Växjö, Sweden.



It is unclear to what extent primary care practitioners (PCPs) should retain responsibility for follow-up to ensure that patients are monitored until their symptoms or signs are explained.


To explore the extent to which PCPs retain responsibility for diagnostic follow-up actions across 11 international jurisdictions.


A secondary analysis of survey data from the International Cancer Benchmarking Partnership.


The authors counted the proportion of 2879 PCPs who retained responsibility for each area of follow-up (appointments, test results, and non-attenders). Proportions were weighted by the sample size of each jurisdiction. Pooled estimates were obtained using a random-effects model, and UK estimates were compared with non-UK ones. Free-text responses were analysed to contextualise quantitative findings using a modified grounded theory approach.


PCPs varied in their retention of responsibility for follow-up from 19% to 97% across jurisdictions and area of follow-up. Test reconciliation was inadequate in most jurisdictions. Significantly fewer UK PCPs retained responsibility for test result communication (73% versus 85%, P = 0.04) and non-attender follow-up (78% versus 93%, P<0.01) compared with non-UK PCPs. PCPs have developed bespoke, inconsistent solutions to follow-up. In cases of greatest concern, 'double safety netting' is described, where both patient and PCP retain responsibility.


The degree to which PCPs retain responsibility for follow-up is dependent on their level of concern about the patient and their primary care system's properties. Integrated systems to support follow-up are at present underutilised, and research into their development, uptake, and effectiveness seems warranted.


cancer; diagnosis; diagnostic errors; diagnostic safety; general practice; primary care; safety netting

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