GP referral management schemes fail to deliver

Half of primary care trusts using referral management believed their schemes had cut demand for secondary care. However, they were no more likely to have cut referrals than PCTs using other methods, the think tank warned in its report Referral Management: lessons for success.

It’s very hard, if not impossible, for a full blown referral management centre to achieve value for money

The report also found some schemes could undermine quality of care, by misdirecting referrals in the absence of clinical information or by delaying patient access to a specialist.

King’s Fund deputy director of policy Candace Imison said there was a wide variation in how referral management schemes dealt with GP referral letters, which themselves varied in quality.

Some centres sought extra information and some tracked patients if referrals were turned down, but others did not.

The report said evidence from GP fundholding suggested GP consortia would turn to referral management because of the financial gap caused by the variation in GP referral patterns.

But Ms Imison said: “It’s very hard, if not impossible, for a full blown referral management centre to achieve value for money.”

This is because they could cause inefficient referral, meaning a re-referral was required, did not guarantee reduced referrals and the cost of running the schemes themselves could be significant.

“We found that most interventionist management approaches from PCTs, such as referral management centres, were unlikely to offer value for money, and could actually increase overall costs to the NHS,” she said.

The most effective strategy for improving referral behaviour was using peer review, audit, consultant feedback and education to change GP referral behaviour, she said.

British Medical Association GP committee chair Dr Laurence Buckman said: “Although there have been examples where some form of referral management has worked well, in general the BMA agrees with the finding in the King’s Fund study that referral management centres are poor value for money. We also believe they can be bad for patients.  

“Doctors agree that care should, where appropriate, be provided closer to patients’ homes, but  the best outcomes for patients will be achieved by GPs and consultants working in partnership, designing pathways and guidelines for patients’ needs which are sensitive to individuals and localities.”  

The King’s Fund report produced seven evidence based principles for commissioners when considering referral management strategies.

These include involving both primary and secondary care clinical leadership and not introducing financial incentives to drive blanket reduction.