{
  "abstract": "This study examines healthcare overuse, focusing on ‘not doing’ decisions and their documentation in UK primary care. ‘Not doing’ refers to a carefully considered decision of non-action aligned with a patient’s medical needs, values, and preferences. Overuse—unnecessary treatments, interventions, referrals, tests, or diagnoses—remains a concern, with primary care settings vulnerable due to diagnostic uncertainty, patient expectations, time pressures, and clinical guidelines. Despite increased awareness, fears around ‘not doing’ persist among healthcare professionals (HCPs), driven by concerns over litigation, peer disapproval, and patient trust, among other drivers. This presentation will present study findings, which explore HCPs’ experiences and documentation practices related to ‘not doing’ to address the research question: In Primary Care within the UK NHS, how can the decision-making processes concerning the choice not to undertake specific actions (’not do) be effectively recorded to instill confidence and reassurance in the HCPs making the decisions? Method To generate qualitative insights, up to 40 semi-structured interviews lasting around 60 minutes will be conducted online. Participants include General Practitioners (GPs), Advanced Nurse Practitioners (ANPs), and Advanced Paramedic Practitioners (APP). Data collection is between 1 August 2024 and 30 April 2025. The interviews, guided by vignettes and developed with collaboration from a Public Involvement (PPI) group members consisting of service users and GPs, will enable discussions of context-specific scenarios related to non-intervention, and data is analysed using Reflexive Thematic Analysis (RTA).Results Preliminary analysis from 20 interviews reveals challenges and systemic issues faced by HCPs regarding ‘not doing’ decisions, as well as differences in documentation practices: Inconsistent Practices - efforts to adopt a ‘not doing’ approach are often undermined by colleagues, frustrating HCPs and eroding patient trust, which can demotivate those aiming to reduce overuse. Patient Expectations - patients frequently expect tangible outcomes from appointments, fostering a transactional mindset that complicates HCPs’ advocacy for ‘watch and wait’ approaches. Time and Emotional Burden - ‘not doing’ demands extended discussions and detailed documentation to justify decisions, safeguard against complaints, and build patient trust, increasing workloads. Documentation Variability - documentation practices vary across multidisciplinary teams, influenced by experience, cultural norms, and defensive practices. This leads to continuity challenges and hinders collaboration in implementing ‘not doing.’ As data collection is completed in April 2025 and further analysed, these themes will be developed and refined for presentation at the conference.Conclusions This study explores the challenges of opting for ‘not doing’ and the variation in approaches to documenting these decisions in UK primary care. These challenges can discourage professionals from prioritising ‘not doing’. The study questions the benefits further guidance on documentation practices could offer to empower HCPs to reduce overuse. The final analysis of the results aims to provide additional insights, offering a deeper understanding of the factors influencing ‘not doing’ and considerations for documenting these decisions.",
  "authors": [
    {
      "affiliations": [
        "University of Leicester, Leicester, UK"
      ],
      "name": "Claire Hastings"
    },
    {
      "affiliations": [
        "University of Leicester, Leicester, UK"
      ],
      "name": "Carolyn Tarrant"
    },
    {
      "affiliations": [
        "City St Georges University, London, UK"
      ],
      "name": "Natalie Armstrong"
    },
    {
      "affiliations": [
        "University of Leicester, Leicester, UK"
      ],
      "name": "Christopher Williams"
    }
  ],
  "title": "017 Accounting for and explaining ‘not doing’ within healthcare – exploring decision-making and documentation practices to address overuse in UK primary care",
  "uid": "79f70b6e-acae-5ddb-9daf-e18ee96f135e"
}