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.