Referral management

The RCGP took a paper to its Council which discussed systems of patient referral. Once it had passed we made the paper into a report Quality Patient Referrals: Right service right time. The report looks at different approaches that are used to review GP referrals to secondary care and whether they meet the standards of a 'good referral.'

We found that the use of referral management centres to control referral rates and to drive down costs is detrimental to quality long term patient care. Despite being intended to save money they are ineffectual in doing so. The RCGP is therefore calling on Clinical Commissioning Groups (CCGs) to stop commissioning referral management centres.

Referral management centres are used by a quarter of Clinical Commissioning Groups in England. Referrals which GPs have made are often denied without patient consultation or any dialogue with the referring GP. This adversely affects the GP patient relationship and can lead to delays in treatment and patients being unable to access the care they need.

Instead of referral management centres the report argues in favour of referral support schemes which aim to improve the quality of referrals by enabling development in the relationships between medical professionals and learning opportunities for GPs. These typically entail:

  • Specialist advice services via which GPs can seek advice from consultants by phone or email about management of a patient or whether they think a referral is appropriate
  • Local expertise initiatives whereby GPs with a special interest in a clinical area, or a consultant, work at a community-level to triage referral letters
  • Peer review and reflection whereby another GP or groups of GPs in the practice review referrals before they are submitted to ensure the most appropriate routes and timely use of investigations. This can also be done retrospectively to inform future behaviour. 

The RCGP is committed to improving the quality of referrals and we believe that implementing the recommendations in the Referral Management Report [PDF] will help achieve this goal and ultimately improve patient care.

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