Table 8 Interview excerpts reflective of the theme ‘Meeting the needs of patients’

“….I think you’re always looking for other options really, do the patients really need to go on an NSAID, you know, more so now than a few years ago, I think sometimes you do feel a little bit sorry for patients, I’m thinking of one particular chap that was riddled with arthritis that said you know he was willing to take his chances with NSAIDs taking them all the time because he felt so much better taking them than he did when he didn’t, everything else he’d tried didn’t help so for him on balance he was happier taking them and going, you know, taking his chances rather than not taking them at all, and I think sometimes you do feel a little bit sad, really, for the patients, but, yeah, I mean you’ve to try and do what’s right haven’t you..”

Nurse Practitioner, Risky prescribing (P28)

“… it depends how complex the patient is, depends on what, what else they’ve got going on and if, if it’s a patient that’s quite happy to take a medication if you recommend it then it’s fine, but if they, if they’re quite resistive or they’ve had side effects to other medications then picking the best one is probably, it can be stressful”

GP, Treatment targets in type 2 diabetes (P13)

“…And I think also for people who are quite elderly and frail, to be on warfarin, maybe when they’ve not go so many, you’re thinking they’ve not got so many years left of their life and they might be prone to falls and that sort of thing, maybe it’s not always appropriate for them…..”

GP, Anticoagulation in atrial fibrillation (P73)

“… it’s a risk benefit thing so if there are no other painkilling options and someone has inflammatory arthritis where anti-inflammatories are known to be an effective painkilling treatment for them, there may be, you may just need to monitor them closer and, and accept that that’s a, a high risk, that balance of risks benefits needs to be taken but after discussing it with the patient”

GP, Risky prescribing (P11)

“… I would imagine every surgery will get some patients who just refuse to come in! There’s not a lot we can do. We write out, we get in touch with them (yes), we document that, you know, at the end of the day if they’re not willing to come in we can’t do anything about it! If they’re housebound we will go to them! (Yes right) we will make sure we’ve done everything we can (ok) to get to see that patient….”

Practice Manager, Blood pressure targets in hypertension (P47)

“… I keep going back to the patient education, again, because that’s the main thing here, if you have ruled out all of it which we are good at anyway, if we are ruling out other things which is affecting why this is not coming under control, so if we have covered all of that, if still, that case scenario, then it’s an individual kind of based on that particular patient what you need to do kind of thing….”

GP, Treatment targets in type 2 diabetes (P8)

“… Identifying the patients getting the patients to come and see you, and then getting them to cooperate and comply with anything that you wanted to do for them…”

GP, Anticoagulation in atrial fibrillation (P66)