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Image: Dr Jonathan Fuld

Dr Peter Harley

Area of study
Systems and culture
Fellowship level
Year awarded
Host university
Department of Population Health Sciences
University of Leicester
Claire is a Paramedic with over 20 years of healthcare experience, over the last 10 years she has also been working in higher education as a lecturer/senior lecturer on a variety of Paramedic programmes. She has studied alongside working full-time and has a MSc in Advanced practice and a PgCert Medical Education.
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Accounting for and explaining ‘not doing’ within healthcare


There is concern that over testing, over diagnosis and over treating within healthcare can cause unnecessary burden to service users through financial stress and, both psychological and physical harm. An alternative approach may be preferable to service users such as choosing to ‘not do’ and actively observe the service users’ condition. This could also benefit over stretched primary and secondary care services through a reduction in demand for appointments, treatments and medication for example.

Shared decision-making aids, promotion of person-centred care and education resources encourage more individualised approaches to care that can help reduce overuse of resources. However, these can be counteracted by healthcare professionals (HCPs) fear of litigation leading to a defensive medicine approach.

This project focuses on primary care and will consider how decision-making can be captured and documented by HCPs in a robust way that is transferrable to other care providers. This could provide HCPs with reassurance and confidence when decisions are made to ‘not do’, leading to a reduction of over-use in healthcare.


The first stage of the project is a scoping review to identify and analyse current tools used by professionals in primary care to record and account for ‘not doing’. The results of the scoping review will be further informed through consultation with an advisory group formed of people currently involved in this area. Tracer themes will be selected and explored through interviews with HCPs from primary care services in the UK.

Finally, the findings from the interviews will be presented to a stakeholder workshop to discuss how people working in primary care could be supported to be more confident in ‘not doing’ through methods of recording their decision-making.

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