Factors influencing English general practitioners referrals to specialist sleep services: a qualitative study using the COM-B model

TitleFactors influencing English general practitioners referrals to specialist sleep services: a qualitative study using the COM-B model ObjectivesThis study explored the factors influencing access to sleep services for individuals with symptoms of OSA and narcolepsy, from the perspective of general practitioners (GP). MethodsA qualitative interview study was conducted with GPs within three areas of England: South London, East Midlands or South West England to explore their views on factors influencing referrals to specialist sleep services. The semi-structured interviews were conducted between November 2024 and April 2025 using an interview guide informed by published research and the COM-B model of behaviour change; this model proposed that Capability (C), Opportunity (O), and Motivation (M) are needed for behaviour (B) change to occur. Data were analysed using exploratory thematic analysis informed by the COM-B model using an iterative approach. ResultsWe conducted 31 interviews, mostly online, with one conducted face-to-face. Our data suggest that the most important factors shaping referral to sleep services are limited capacity of NHS sleep services, limited referral pathways for narcolepsy, inflexible referral pathways for OSA, and limited knowledge of narcolepsy. ConclusionsThis qualitative study with GPs in England highlights that, although sleep disorders are a common concern, the current healthcare system provides limited support for GPs in managing these conditions. Fundamental sleep medicine service reforms are needed to improve referral pathways. These reforms should be guided by data-driven research that assesses current services in relation to population health needs and evaluates the potential health and economic benefits of expanding service capacity.