Referral management centres (RMCs)
While RMCs are designed to reduce referrals to secondary care, the BMA has argued against their use due to concerns about their accountability and the transparency of the clinical decision-making process.
With the introduction of e-RS, the purpose of RMCs is increasingly unclear, and we believe that they should be phased out completely. e-RS provides the ability for direct clinician to clinician referral, and for advice and guidance to be provided between clinicians through a convenient, transparent and professional process.
Referral assessment services (RAS)
As part of the e-RS programme, NHS England has introduced referral assessment services (RAS), which now allow providers to:
- Assess the clinical referral information from the GP/referrer
- Decide on the most appropriate onward clinical pathway
- Contact the patient to discuss choice (if an elective referral)
- Arrange an appointment, where needed
- Return the triage request to the original referrer with advice, if an onward referral isn't needed
This new facility supports complex care pathways, such as gastroenterology and cardiology, where it is not always clear whether a patient needs a consultant appointment or a diagnostic test. A RAS set up by the provider will ensure patients' referrals are triaged correctly.
However, while the aim of this new facility is to increase direct engagement with the referring clinician and the patient referred, it is likely to take up a reasonable amount of time for some consultants and SAS doctors and this should be included as part of their job plan.
Integrated care pathways
As new models of care are implemented, it will be essential that e-RS is reviewed and adapted to ensure that the system is ready to incorporate and work effectively with new care pathways. This is preferable to local workarounds which risk upsetting pathways which are proven to be efficient and beneficial to patient outcomes.
If clinicians experience e-RS to be an obstruction to the management of patient care, please contact the BMA so that this can be investigated.