Inquiry into the quality of general practice: diagnosis and referral

General practice plays a central role in ensuring patients receive a timely and accurate diagnosis, either directly from a GP or from an appropriate specialist as a consequence of a GP referral. Failure, or delay, in correctly identifying and referring patients who need secondary care can have profound clinical consequences.

What did we explore?

To inform its work, the Inquiry panel commissioned a research project to examine what good-quality diagnosis and referral by general practice looks like, and how it can be measured. The quality of GP diagnosis and referral looks at variations across general practice, and identifies evidence-based ways to improve the quality of this core aspect of GP care. The paper is written by a team from The King's Fund: Catherine Foot, Chris Naylor and Candace Imison.

What have we learnt about diagnosis and referral?

In March 2010 the Inquiry held a seminar on diagnosis and referral with participants including GPs, practice nurses, NHS executives, health academics and patient representatives.

Key issues raised in discussion include:

• Has the introduction of the 'Choose and Book' referral process undermined the relationships between GPs and individual hospital consultants, to the detriment of patient care?

• How might judgements be made about what degree of variation in diagnosis and referral ought to be deemed acceptable, and therefore at what level any quality indicator thresholds ought to be set?

• Are the growing number of clinical guidelines mitigating against their utility in general practice?