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Published online by Cambridge University Press: 14 November 2008
Service providers are able by virtue of the nature of their work to shape how services operate and to influence who receives them. Of the many occupational groups involved in delivering care to the elderly general practitioners perform a pivotal role. While the ‘gatekeeper’ function of GPs is widely acknowledged there is little understanding of how this is actually performed or of the criteria underpinning decisions in regard to referrals and admissions. Old people display a complex of presenting conditions both physical and social with which the GP has to contend. At the same time services do not operate in isolation but interact in many subtle and not so subtle ways. To illustrate these themes the paper identifies and explores a set of considerations that appear to influence a group of GPs' use of services when referring patients to the geriatric service and admitting them to local hospital beds under their control.
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