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This report analyses the data collected in a study of the general practitioner referral process and outpatient system in a district general hospital in south-east England, with specific reference to general medicine. In a second report to follow interview and observational material is used to explore explanations for the general trends seen in the results.

This report is about the referral process and it analyses material recorded in interviews with 45 general practitioners. Data collected from the general medicine clinics and pathology and radiology departments of a district general hospital in south east England were presented in the First Reportl The interviewed doctors had differing patterns of medical practice for certain endocrine diseases which traditionally have been referred to hospital. Variations were also observed in the doctors' clinical judgement when working-up similar cases, particularly in their use of biochemistry work. The pathology data in the First Report confirmed these differing patterns of use. Increased waiting times for barium studies mainly affected the doctors when they suspected a patient of having a malignancy. There were different ways of coping. Some telephoned the consultant radiologists to arrange an urgent appointment while others referred the patient direct to the outpatient clinic. There was, as well, a group of doctors who were routinely substituting barium meals with gastroscopy referrals. The interviewed doctors in general though, did not want open access to the gastroscopy service.

An examination was made of the need in a group practice serving a semirural area for a transport service to carry to the main surgery, a health centre, selected patients who would otherwise have received a home visit. The possibility that such a service could bring attenders at the branch surgery five miles distant from the health centre into the centre and so permit the closure of the branch surgery, was also considered. Data were collected over two periods of a month in 1968, on all direct contacts with patients with practice doctors and nurse. Information on public transport services and from the 1966 sample Census was also used. It was concluded that introducing a practice transport service to transfer selected consultations from the patients' homes to the main surgery would only save the doctors small amounts of time randomly distributed over their working week with no clearly established benefits accrueing to the patients concerned. Running such a service would not justify the cost involved. The closure of the branch surgery and its replacement by a bus service connecting the village and the main surgery twice a week would result in considerable extra expense to the practice though it would offer village patients without private cars more frequent opportunities to attend the surgery and a wider range of doctors to see in the surgery. It was recommended that the branch surgery should be retained and consideration given to using it more intensively.

This is the report of a study of the work of three general practitioners and of the views and experiences of some, of the patients before and after the opening of a health centre in Carterton, Oxfordshire. This centre replaced the branch surgery of one practice (with whlch the study is primarily concerned) and provided branch surgery accommodation for another in a residential area rapidly growing up around what was originally a small village.

This supplement contains a much fuller set of tables arising from the study concerned with Carterton Health Centre than is provided in the main report.

This study sought the opinions of a sample of patients on the Henfield Health Centre (some 19 months after it had opened), and their experience of care received from those working at the centre. Admittedly, the views of patients about the care they received may be based on a number of ill-defined factors, related loosely, if at all, to the quality of medical care received.

Health services research is taken to include all research intended to help operate or improve health services; it is concerned with problems in the organisation, staffing, financing, utilization, and evaluation of health services. This is in contrast to biomedical and clinical research which is concerned with the aetiology, diagnosis and treatment of disease. The broad purpose of health services research is to produce knowledge that will contribute to improving the delivery of health care (Flook and Sanazaro, 1973).