title: General practitioners' perceptions and attitudes to infertility management in primary care: focus group study.
abstract: BACKGROUND
  Infertility management in primary care is variable. National Institute of Clinical Excellence have recommended hysterosalpingography (HSG) as a first-line investigation for tubal assessment. Aim To explore general practitioners' (GPs) perceptions of, and attitudes to, the initial management of the infertile couple and their views on open access to HSG.
  
  
  METHODS
  
  
  
  METHODS
  Qualitative study using three focus groups.
  
  
  METHODS
  Seven general practices in Newcastle upon Tyne and Northumberland.
  
  
  METHODS
  We purposively selected the three focus groups to provide a range of GPs' views. In total 13 practitioners participated: 11 GPs, one GP registrar and one nurse practitioner.
  
  
  RESULTS
  The key themes to emerge were: (1) perceived professional responsibilities, (2) uncertainty and lack of knowledge, (3) consistency of approach to the initial management of infertility, and (4) access to infertility services. Some GPs felt that they should do all they possibly could, while others felt it was the responsibility of the infertility specialist. Uncertainty and lack of knowledge was linked to the relative infrequency of primary care infertility consultations and the difficulty 'keeping up to date' with rapidly advancing reproductive technologies in tertiary care. Some GPs subscribed to the notion of one suitably trained clinician delivering the service on behalf of a group of GPs. Some were unsure where HSG fitted into the overall management plan, but they were comfortable with following recommended guidelines.
  
  
  CONCLUSIONS
  GPs recognize an advocacy role and many take on a significant degree of clinical responsibility welcoming the introduction of a new technology in primary care. Nevertheless, GPs feel that they lack proficiency and have little opportunity to rehearse the necessary skills. These findings contribute to an understanding of the management of infertility, an infrequently presenting problem in primary care.
authors.affiliation: Centre for Primary and Community Care, School of Health Natural and Social Sciences, University of Sunderland, Sunderland, UK. scott.wilkes@sunderland.ac.uk
authors.forename: Scott
authors.initials: S
authors.lastname: Wilkes
authors.forename: Nicola
authors.initials: N
authors.lastname: Hall
authors.forename: Ann
authors.initials: A
authors.lastname: Crosland
authors.forename: Alison
authors.initials: A
authors.lastname: Murdoch
authors.forename: Greg
authors.initials: G
authors.lastname: Rubin
mesh_terms: D001291:Attitude of Health Personnel; D017144:Focus Groups; D006801:Humans; D007246:Infertility / Q000628:therapy*; D010821:Physicians, Family / Q000523:psychology*; D011320:Primary Health Care; D013222:State Medicine; D006113:United Kingdom