Table 2 Summary of the sources of powerlessness perceived by GPs as preventing them from influencing childhood hospital admissions

Patient

▪Patient morbidity

▪Health service use behaviour

▪Parents request second opinion

▪Caregivers failure to give medication

▪Chaotic lifestyle of caregiver

▪Parents coping strategy

▪Severity of illness

Health care system

▪Lack of facilities to observe sick children

▪Lack of senior doctors in emergency department

▪Varying quality of out-of-hours care physicians

▪Inadequate health care facilities

▪Varying admission thresholds at hospital

Societal

▪Education of population

▪Outbreaks of illnesses

▪Bank holidays / vacation dates

▪Conflicting health messages

▪Deprivation and poverty

▪Cultural factors