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RCGP: CCGs must weigh-up use of referral management centres

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26 February 2018

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There is a ‘dearth of evidence’ that referral management centres are cost effective and safe for patients, a Royal College of General Practitioners (RCGP) report has suggested.

The RCGP is now calling to end referral management centres unless commissioners can prove their effectiveness.

Around a quarter of CCGs in England have been using referral management centres since 2014, with some judging them a viable scheme, the report found.

There is a ‘dearth of evidence’ that referral management centres are cost effective and safe for patients, a Royal College of General Practitioners (RCGP) report has suggested.

The RCGP is now calling to end referral management centres unless commissioners can prove their effectiveness.

Around a quarter of CCGs in England have been using referral management centres since 2014, with some judging them a viable scheme, the report found.

However, the report said: ‘There is a dearth of evidence to suggest that referral management centres are effective in controlling expenditure.

‘The RCGP does not support the use of referral management initiatives, which are primarily designed to reduce referral numbers by imposing external control measures onto GP referrals’.

Commenting on the report, an NHS England spokesperson said: ‘The NHS wants patients to get faster access to the right specialist first time.

‘That’s why local NHS bodies are working with their GP practices to develop the type of referral support supported by this report.’

Risk to safety?

The RCGPs is worried that these centres might involve risks to patients’ safety, as they claim that decisions are sometimes made in absence of full clinical information or the patients themselves.

Referral management centres impose an external control onto the referrals made by GPs. They are in charge of ‘triaging referral letters from GPs, linking referrals to booking centres, deciding the treatment route for a patient, diverting referrals to alternative services and determining whether a referral should not have been made’.

The RCGP claimed that these functions could ‘undermine GPs’ professionalism’ and their relationships with colleagues in secondary care. They could also worsen patients’ trust in their GP, cost more to the NHS by increasing the length of the referral process and further fragment the health system, it said.

Referral support VS referral management

Instead, GPs should receive ‘referral support’ from consultants or fellow GPs, working at community level or in their same practice.

Chair of the RCGP, professor Helen Stokes-Lampard, said: ‘GPs need referral support, not referral management. We hope that CCGs and other decision-makers in the health service will read this report and take heed of our recommendations, in the best interests of our profession, the wider NHS and our patients.

‘They also overlook that only around one in 20 consultations results in a referral – accounting for just over half of all referrals to secondary care. Family doctors will not make referrals without a good reason for doing so.

‘We know that CCGs often have to make difficult decisions. But good quality evidence that referral management centres are cost-effective does not exist.’

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