The purpose of this study is to examine whether the implementation of a referral template will increase quality of health care delivered and the quality of health care co-operation. The investigators intent to implement a referral template, at the level of the general practitioner (GP), for the referral of patients within 4 separate diagnostic groups:

• dyspepsia/upper GI symptoms
• colonic cancer investigation/lower GI symptoms
• chronic obstructive pulmonary disease (COPD)
• chest pain

Local GP clinics will be randomised to use the referral template or to use standard referral practice. Using a predefined set of quality criteria the investigators will score the process of care in each patient, and compare intervention and control groups. In addition other criteria will be collected and compared between the two groups, e.g.

• time to diagnosis/treatment
• quality of referral
• more appropriate referrals
• patient satisfaction (as measured by a questionnaire)

The investigators hypothesize that the implementation of a referral template will lead to a measurable increase in the quality of health care delivered.

There is a continuous work to improve the quality of health care delivered to an individual patient, both in primary and secondary care. The referral from primary to secondary care represents a key component in the communication between the levels of care, and therefore an important tool in developing the quality of care. There has been many attempts at improving the quality of referrals, but less work has been focussed on the consequence of such improvement on quality of health care. This study is designed as a randomised controlled intervention study where we intent to implement a referral templates, at the level of the general practitioner (GP). These templates will be for the referral of patients within 4 separate diagnostic groups:

• dyspepsia/upper GI symptoms
• colonic cancer investigation/lower GI symptoms
• chronic obstructive pulmonary disease (COPD)
• chest pain

Following the course of the health care process we will assess the quality of the care process by using predefined quality of care criteria, together with patient satisfaction (as measured by questionnaire) and other health process indicators.

Our primary hypothesis is that the implementation of a referral template in the communication between primary and secondary care, will lead to a measurable increase in the quality of health care delivered.

Secondary hypothesis include:

• the use of a referral template in the communication between the GP and secondary care, will lead to better patient satisfaction.
• the use of a referral template in the communication between the GP and secondary care, will lead to a change (up or down) in the amount of patients defined as being in need of prioritisation (as defined pr. national guidelines for prioritisation in health care)
• the use of a referral template in the communication between the GP and secondary care, will lead to a measurable referral quality improvement
• the use of a referral template in the communication between the GP and secondary care, will increase the "appropriateness" of the referrals

Inclusion Criteria:

• referral to medical department of University Hospital of North Norway, Harstad

Exclusion Criteria:

• children (< 18 years of age)
• patients with reduced capacity to consent