Consultant General practitioner England

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Referral management in England

Woman GP with patient

This briefing provides an up to date account of the referral management schemes that are currently operating in England and summarises existing evidence regarding their effectiveness.

The briefing also provides the BMA’s view on referral management and makes several recommendations for change. 

Download the full briefing

 

  • BMA position on referral management

    The BMA has repeatedly raised concerns about the use of referral management schemes in England. In 2009, we issued guidance to members which condemned the use of financial incentives to reduce referrals, the review of referrals by non-clinicians and the use of scheme that lengthen or complicate the patient journey. The guidance advocated for schemes which facilitate communication and collaboration between primary and secondary care and schemes that offer an educational element.

    In 2017, the BMA GPC (General Practitioners Committee) voiced concerns over the continued commissioning of referral management schemes without sufficient evidence or evaluation. Later that year, the GPC was successful in spearheading a campaign against NHS England plans to introduce ‘peer review’ of all GP referrals.  Following NHS England’s abandonment of those plans, GPC stated that ‘GPC will continue to recommend local schemes retrospectively reflect on the quality of referrals, be voluntary, properly resourced and take a supportive approach.’  

    The BMA continues to encourage doctors to take part in initiatives which enable better communication between GPs and local consultants and/or create opportunities for professional development with the primary focus of improving patient care. However, the BMA does not support referral management schemes which encourage the blanket reduction of referrals in order to save costs, which are poorly evidenced and carry many risks to the patient and in terms of long term costs.

    The BMA has also recently called upon NHS England and the UK Government to clarify that the clinical responsibility will rest with the individual making the decision that a referral may or may not proceed.

  • Recommendations

    In the briefing, the BMA makes the following recommendations based on analysis of available evidence and the views of BMA members:

    CCGs 

    1. CCGs should undertake formal evaluations of all referral management schemes in operation. Evaluations should consider effectiveness, cost effectiveness and the impact on patients and doctors.
    2. CCGs should not commission RMCs (Referral Management Centres) which have been shown to be largely ineffective in terms of cost and in reducing inappropriate referrals, and which pose significant risks to patients and doctors.
    3. CCGs should develop referral pathways that enhance communication between GPs and local consultants and which facilitate appropriate advice, guidance and collaborative care. 

    NHS England and Government 

    1. NHS England and the UK Government must clarify that the clinical responsibility will rest with the individual making the decision that a referral will or will not proceed.
    2. NHS England should publish data on the total number of GP appointments that occur per year to enable analysis of the overall referral rate (the percentage of GP appointments which result in a referral).
    3. NHS England should publish a breakdown of first outpatient attendances by referral source in each CCG to enable analysis of the overarching impact of referral management schemes on quantity of referrals.
    4. NHS England and Government should cease pressure on CCGs to reduce referrals, especially prior to undertaking proper analysis of rising demand.