Referral management centres criticised

Providing GPs with more information about referrals would be a more effective strategy for cutting costs and improving quality than setting up referral management centres, according to the King’s Fund.

An investigation by the think-tank found that referral management centres were failing to deliver savings and that some schemes could undermine quality by delaying access to specialists or misdirecting referrals.

Candace Imison, lead author of the research and deputy director of policy at the King’s Fund, said: “We found that the most interventionist management approaches from primary care trusts – such as referral management centres – were unlikely to offer value for money and could actually increase overall costs to the NHS.”

The report, Referral management: lessons for success, says a more effective strategy for commissioners would be to improve the information that is collected and fed back to GPs, such as comparative referral rates by specialties.

It adds: “Greater use of new technologies could be an important enabler. GPs’ capacity to refer appropriately would be greatly strengthened by access to decision-support tools, up-to-date information on local services, regular feedback from audit of their referral activity, and opportunities to communicate with other clinical professionals – including consultants – via email and telephone.”

The report says GP commissioners and PCTs could also focus on reducing procedures of limited clinical value, review clinical pathways to highlight evidence that supports alternative and less invasive treatments, and collect more robust information on patient needs to redefine pathways.

It says patients could also be supported by enabling them to track their referrals via the internet and, if referrals were managed through a central facility, ensuring easy access by telephone for patients with extended opening hours and a rapid response to calls.

The research foundmore than 9m referrals were made by GPs last year at a cost of more than £15 billion. Referrals to outpatient increased by 19%. Evidence showed that not all GP referrals into secondary care were necessary or required care in a hospital setting.

The review found many PCTs began referral management schemes to support the implementation of choice and Choose and Book, but that most schemes had now evolved to support referral diversion and out-of-hospital services.

It said many GPs conflated Choose and Book and referral management centres and perceived that referral management was driving a wedge between primary and secondary care.

However, the report’s authors argue that GP commissioners are likely to turn to referral management strategies when they take responsibility for the bulk of the NHS commissioning budget.

They hope the report could be used as a practical tool to identify suitable ways of improving the quality and appropriateness of referrals.