Transfer of care and inbox management in primary care: a survey on medico-legal responsibility awareness and administrative burden in Aotearoa New Zealand.

Abstract

Background: Copying results to a patient's primary care provider confers a medico-legal responsibility to take action, which can complicate transfer of care. This practice contributes to administrative burden and creates uncertainty around the continuity of patient care. We aimed to survey primary care, with a focus on general practitioners (GPs), regarding their medico-legal awareness, preferences regarding receiving copied results, views on when transfer of care should happen, work-life balance, career pathway and the administrative burden (non-patient-facing clinical time) within their total clinical work hours.

Methods: This was an anonymous, cross-sectional survey for clinically active primary care clinicians (GPs, urgent care physicians, nurse practitioners [NPs]) in the Northern region of Aotearoa New Zealand. The survey link was open from August to October 2023 and distributed via email, promoted during webinars and shared on social media.

Results: A total of 470 eligible responses were collected: 428 GPs, 15 urgent care physicians, 18 NPs and 9 doctors that identify as "other primary care". Across the professions, 34% were unaware of the medico-legal responsibilities of being copied into results they did not initiate. With the exception of NPs, most primary care clinicians prefer to not be copied to radiology, histology, microbiology, haematology and biochemistry results they did not order. Four out of five participants agreed that any results copied to primary care should involve prior discussion and acceptance by a relevant clinician. Although GPs and NPs reported poorer work-life balance, lower job satisfaction and higher rates of burnout compared with the other primary care professions, all professions have seen reductions in their patient-facing hours in the past 5 years, with increased administrative burden identified as a major contributing factor. Indeed, 47.7% of the GPs surveyed stated their intent to leave primary care within the next 5 years. The median proportion of non-patient-facing clinical hours as part of total clinical hours was 31% for GPs, 17% for urgent care physicians, and 31% for both NPs and other primary care professionals. Among GPs, a higher proportion of non-patient-facing clinical work was associated with older age, female gender, other non-European ethnicity, holding vocational registration in general practice, more years of general practice experience, having a personal list of enrolled patients and working in a non-Very Low Cost Access practice. However, medico-legal awareness of copied results was not associated with an increased proportion of non-patient-facing clinical work.

Conclusion: A gap in medico-legal knowledge related to test result responsibility exists within the primary care workforce. While this deficit was not linked to increased time spent on non-patient-facing clinical work, the majority of clinicians expressed a preference to not be routinely copied into test results unless a closed loop communication process with the ordering clinician is established. Improving the viability of primary care as a profession and patient care productivity will require coordinated efforts between primary care providers and Health New Zealand - Te Whatu Ora to reform current practices and uphold the principles of "Transfer of Care and Test Results Responsibility".