Referral management

The College report Quality Patient Referrals: Right service right time (PDF file, 657 KB) highlighted how some systems of referral management prioritise cost saving over patient care. Clinical Commissioning Groups (CCGs) run referral management centres, and better alternatives exist.

More on referral management

In February we published Quality Patient Referrals: Right service right time (PDF file, 657 KB). It looked at systems of referral management. We examined the use of referral management centres to control referral rates and to drive down costs. We found is detrimental to quality long term patient care. Despite being intended to save money, they are ineffectual in doing so. We are therefore calling on CCGs to stop commissioning referral management centres.

Referral management centres are used by a quarter of CCGs in England. Referrals which GPs have made are often denied. This is without patient consultation or any dialogue with the referring GP. This adversely affects the GP-patient relationship. It can also 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. These aim to improve the quality of referrals. This is by enabling development in the relationships between medical professionals and learning opportunities for GPs. These typically entail:

  • Specialist advice services. Through these, GPs can seek advice from consultants by phone. They can also email about management of a patient, or discuss whether they think a referral is appropriate.
  • Local expertise initiatives. Through these, 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. Through this, another GP or groups of GPs in the practice review referrals. Then 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. We believe that implementing the recommendations in the Referral Management Report (PDF file, 657 KB) will help achieve this goal. Ultimately, this will improve patient care.