1. Difficulties in handover between primary and secondary care | Ambiguous roles and responsibilities
‘Look how confusing it is. Who do you see, when do you see them, who do you refer them to? There’s no simple pathway.’ (health professional)25 ‘One of the core issues is that you’ve got a resource constrained situation, [clinicians] are full to the brim […] Their job is 120%, so anything else you give them, is a problem.’ (public health specialist)23 ‘It’s not that people are not aware that [screening] needs to be done, it is because the environment will be challenging for people to be doing OGTTs. That’s associated with human as well as financial resources.’ (obstetrician)23 Communication difficulties
‘I personally hate those […] discharges, they are impossible! I mean something much more succinct, a summary. They obviously have printed the entire record!’ (GP)26 Discharge summaries that: ‘Tell us how she is going, what you have done, what you are going to do and what you want me to do.’ (GP)26 ‘No proper system to identify and retain patients in the current care model.’ (primary care clinician)21
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2. Short-term focus in consultations |
‘We present it like “okay, you have GDM, it’s a potential risk, but it’s not technically affected the baby per se.” I think we may be part of it […] that we maybe simplify it so they don’t see it as “oh it’s not going to kill my baby right”.’ (community nurse midwife)20 ‘Our focus is the pregnancy, keep the sugar down, try and have a healthy baby and a mother that’s not injured during the birth. And we don’t think too much to the afterwards.’ (professor in obstetrics)23 ‘You see the patient and talk about the baby but not beyond.’ (unspecified)22
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3. Patient barriers |
‘They’ve got too many other things.’ (GP)28 ‘They’re so focused on the here and now they can’t even comprehend what might happen in the future.’ (health worker)25 ‘The drink, a lot of people don’t like it, so they won’t come in for it. And the time it takes to have it as well.’ (health worker)25
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