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RCGP: ‘Ethically questionable’ referral management centres ‘prioritise savings over care’

Referral management centres should not be introduced at all, but where they already exist they must demonstrate that they are safe for patients and cost-effective for the NHS, the Royal College of GPs (RCGP) has warned today.

In a report, the royal college says that there is a “dearth of evidence” that the centres, which are used by around a quarter of CCGs in England, are cost effective.

It states that the centres, which are designed to reduce total GP referral numbers to hospital, are ultimately more expensive to run than other systems designed to improve and maintain the quality of GP referrals.

Although the document found that some referral management centres are considered successful by those involved in their running and commissioning, the RCGP is concerned that some risk patients’ safety, warning that clinical decisions are often made in the absence of the patient and without full clinical information.

Additionally, it claimed that the centres “undermine patient choice” and the trust that they have in their doctor, as well as undermining the clinical knowledge and professionalism of GPs and their relationships with their secondary care colleagues, and further fragmenting the health system.

It also argued that it increases the future cost to the NHS by referring back to the GP for reconsideration of alternative referral routes or when a patient’s condition changes.

In response to its findings, the college has suggested that systems of “referral support,” such as specialist advice services, local expertise initiatives or peer review and reflection, have been demonstrated to be more effective in improving the quality and appropriateness of GP referrals.

Professor Helen Stokes-Lampard, chair of RCGP, said that the college can’t “simply sit back and say nothing” about “some ethically-questionable initiatives that prioritise cost-savings over patient care.”

She added that whilst the royal college understands that the NHS is cash-strapped and that there is a need for CCGs to make difficult decisions, there is no good-quality evidence that referral management centres are cost effective.

“What they do is undermine GPs' professionalism and the decisions we make in the best interests of our patients, and in doing so erode the important trust our patients have in us,” she continued. “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.

“Reviewing referrals is an important part of general practice, and a constructive part of professional development for GPs, but it must be proportionate, safe, and in the best interests of individual patient’s health outcomes.

“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.”

Robina Shah, chair of the royal college’s Patient and Carer Partnership Group, added that the relationship between a patient and their doctor is unique in healthcare and built over time, so “we must approach any initiatives that threaten this with great caution.”

“I trust my GP to make the right decision about my referral – I don't want bureaucracy getting in the way,” Shah concluded.

Top image: amphotora

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