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Behaviours – Primary & Secondary Care Interface
  • Section II.

    Professional Attitudes and Behaviours influencing the interface

Silo working and work pressure.

Many GPs and specialists rarely meet colleagues outside their immediate team due to pressure of work. They concentrate on maintaining their own knowledge and expertise. This may lead to failing to appreciate how work and constraints exist for different groups of doctors, both in different specialties and grades. There is little joint training or CPD as much is now done on line. Doctors may have little understanding of what other disciplines or specialists can or cannot do.

Workload shift.

High workload and financial pressures may lead to less time to spend with individual patients and in planning care. Some doctors will be pushed to meet service or performance targets rather than delivering patient centred care. It may seem easier to shift the work to other practitioners.

Low morale.

Some doctors have a perception that managers or others do not value professionals and their skills. Fragmentation of care and not feeling part of a recognised clinical team can lead to a feeling of constantly struggling to work collaboratively. Doctors are often reluctant to ask for help, particularly for emotional support. All these factors can lead to low morale and demotivation. Such feelings can impair efficient working and a loss of consideration for colleagues.

Communication skills.

Not all training programmes provide adequate training in effective communication (both verbal and written). Learning to share information with colleagues as well as patients should be a core skill. Many doctors do not give clear guidance to patients about what they should expect or what further action is needed so that patients need to make further contact with other practitioners for explanations. The importance of transferring appropriate and correct information across the interface in a timely manner is not always appreciated.


Doctors may make or imply derogatory comments about another doctor or group of doctors to either colleagues or patients. This may arise from ignorance, insecurity or arrogance. This can create uncertainty or lack of confidence amongst patients and other healthcare professionals, undermine the work of others and increase pressure on colleagues.