They were less sure about the major distinction being whether appointments were given or requested, and suggested the issue was more around the certainty of the hospital setting compared with uncertainty in, and continuity through, the GP setting. Co-ordination: The finding of poor co-ordination between services was of moderate confidence, mainly due to methodological concerns, and the finding of models to co-ordinate care was rated low confidence. Lay members explained that there were resources out there, but people with heart failure were not told about them, and they were therefore under- utilised. The committee agreed that HF nurses were usefully able to provide a bridge between primary care and hospital-based services. The committee felt that HF specialist nurses would ideally co-ordinate care of HF for people who are being actively managed by specialist services, but that this could be passed to general practitioners once the patient was stabilised and on optimal treatment. Communication: The subfinding of poor communication between services was rated as moderate confidence due to methodological limitations. The subfindings of barriers to clear communication was rated as low confidence due to methodological and adequacy concerns. The professionals on the committee felt that problems with communication occurred in their workplace. It was their experience that they commonly needed to have a three-way conversation or more, and that services can require a full-time administrator in order to facilitate good communication. The committee noted that the system relied upon letters going between care settings, in the absence of a universal NHS information system. The subfinding of information after discharge from HF services being insufficient was rated as very low due to methodology and it having come from only one paper. However, the committee recognised that this was a significant issue. 