CCGs have spent £57m on schemes that screen patient referrals from GPs to specialist services in the last three years.
An investigation by The BMJ has found that two in five of CCGs use a referral management system of some kind, a third of which are provided by private companies.
However, only just over two-thirds of CCGs with schemes disclosed operating costs, totalling £57m spent since April 2013.
CCGs have spent £57m on schemes that screen patient referrals from GPs to specialist services in the last three years.
An investigation by The BMJ has found that two in five of CCGs use a referral management system of some kind, a third of which are provided by private companies.
However, only just over two-thirds of CCGs with schemes disclosed operating costs, totalling £57m spent since April 2013.
According to The BMJ, some of the schemes aim to reduce costs, but almost three quarters of the CCGs that responded were unable to provide evidence showing whether or not their scheme had saved money.
Based on figures from CCGs that did disclose operating costs, a total of £57m has been spent on referral schemes since April 2013.
Clinicians and The BMA have warned that CCGs risk repeating mistakes of predecessor organisations by commissioning schemes of questionable effectiveness.
Richard Vautrey, deputy chair of the BMA’s GP committee, said “[CCGs] are leaping at these schemes without any clear evidence of benefit and that they’re just hopeful that it might reduce their costs.
“It is a very, very short-term approach to healthcare management. We need to see much more evaluation… and not just keep making the same mistakes year after year.”
He added: “As public bodies, there should be an expectation on every CCG to account for what it’s doing.”
But some of the schemes that enabled local specialists to provide rapid advice and guidance to GPs “can be very helpful”, explained Vautrey.
The BMJ sent freedom of information requests to every CCG and of the 184 CCGs that responded, 72 said they currently commissioned some form of referral management scheme to help manage outpatient activity in local hospitals.
The 72 CCGs run a total of 93 schemes, with some CCGs operating more than one.
Of these schemes 32% are run by private companies, 29% in house, 11% by local NHS trusts and another 11% by NHS commissioning support units.
Graham Jackson, co chair of NHS Clinical Commissioners, said referral management was just one mechanism that local groups use to try to manage demand for services.
He said: “In many cases they provide a useful and effective role which is more than a redirection service.”
He added: “CCGs will balance the cost of commissioning with the benefit they provide to GPs and patients in terms of peer review, education, caseload management and choice.”
