Notes to editors
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The research involved data analysis, literature reviews, case study analysis and interviews with PCT personnel working in referral management. The research targeted the PCTs undertaking the most active referral management strategies.
Referral management centres were created by PCTs in England to manage the rising costs of unnecessary or inappropriate hospital referral by GPs by undertaking clinical triage of referrals to secondary care, with powers to redirect or refuse referrals.
The report concluded that successful referral management strategies were likely to include peer review and audit, to be linked to clear referral criteria and evidence based guidelines and to a system enabling and using consultant feedback.
The seven evidence-based principles for commissioners to consider in respect to referral management strategies are:
- Any intervention to manage referrals cannot look at the referral in isolation but needs to understand the context in which the referral is being made.
- Changing referral behaviour is a major change management task that will require strong clinical leadership from both primary and secondary care.
- There are inherent risks at a point of clinical hand-off, and any referral management strategy needs to have robust means to manage those risks.
- There may be just as much under-referral as over-referral by local GPs, a strategy to reduce over-referral could and indeed should also expose under-referral and this will limit the potential reductions in demand.
- Commissioners should not introduce financial incentives to drive blanket reductions in referral numbers.
- Reductions in referrals from one source can be negated by rises in referrals from other sources. Any demand management strategy needs to consider all referral routes not just target one.
- A whole systems strategy will be required to manage demand, with active collaboration between primary, secondary and community care services.
This report, Referral management: lessons for success, is part of a series of publications in The King’s Fund’s Quality in a Cold Climate programme, which aims to help the NHS respond to the challenge of unprecedented budget constraints while improving the quality and experience of care and meeting growing demand for health care.
The King's Fund is a charity that seeks to understand how the health system in England can be improved. Using that insight, we help to shape policy, transform services and bring about behaviour change. Our work includes research, analysis, leadership development and service improvement. We also offer a wide range of resources to help everyone working in health to share knowledge, learning and ideas.