Table 1.
Endorsement of consultation complexity factors in two rounds of Delphi study
| Consultation variables: final wording | Round 1result | Median scorea | Round two result | Median scorea | Final status |
|---|---|---|---|---|---|
| Factors accepted or rejected in round one | |||||
| Patient presents with problem of being homeless | ✓ | 3.0 | – | – | Included |
| Patient presents with problem which raises child protection or adult safeguarding concerns | ✓ | 4.0 | – | – | Included |
| Patient presents with problem which raises concerns about domestic violence | ✓ | 4.0 | – | – | Included |
| Consultation about learning disability/autism | ✓ | 3.0 | – | – | Included |
| Discussion about end-of-life issues in current consultation | ✓ | 3.0 | – | – | Included |
| Consultation about mental health problems | ✓ | 4.0 | – | – | Included |
| Multiple diagnoses or problems being managed in the current consultation | ✓ | 3.0 | – | – | Included |
|
| |||||
| Factors carried forward to round two | |||||
| Consultation about dementia | ? | 3.0 | ✓ | 3.0 | Included |
| Discussion about problematic drug or alcohol use in current consultation | ? | 3.0 | ✓ | 3.5 | Included |
| Several preventive healthcare and routine monitoring tasks being conducted in same consultation | ? | 3.0 | ✓ | 3.0 | Included |
| Procedures or minor surgery carried out in the current consultation | ? | 2.0 | ? | 2.0 | Rejected |
| Needing to prescribe many drugs in the current consultation | ? | 3.0 | ✓ | 3.0 | Included |
| First GP consultation following a diagnosis of cancer | ? | 3.0 | ✓ | 4.0 | Included |
| First GP consultation following a diagnosis of diabetes | ? | 3.0 | ✓ | 3.0 | Included |
|
| |||||
| Factors suggested by participants and included in round 2 | |||||
| Medically unexplained symptoms raised in consultation | – | – | ✓ | 4.0 | Included |
| Consultation results in outpatient referral | – | – | × | 2.0 | Rejected |
| Consultation results in an emergency hospital admission | – | – | ✓ | 4.0 | Included |
| Consultation results in urgent secondary care assessment, for example, crisis team/A&E | – | – | ✓ | 4.0 | Included |
| Consultation about chronic pain management | – | – | ✓ | 3.0 | Included |
A&E = accident and emergency. ✓ endorsement.? uncertain. × rejection.
a
Scores: 1 = no more complex than the average consultation; 5 = very much more complex than the average consultation.