Research Article

Extracontractual referrals in first three months of NHS reforms.

BMJ 1991; 303 doi: (Published 31 August 1991) Cite this as: BMJ 1991;303:497
  1. B Ghodse,
  2. S Rawaf
  1. Merton and Sutton Health Authority, Mitcham, Surrey.


    OBJECTIVE--To describe the extracontractual referrals of residents of Merton and Sutton Health Authority during the first three months of the NHS reforms in terms of the nature of the referral (elective or emergency), the specialty referred to, and the source of and reason for referral. DESIGN--Descriptive analysis of all extracontractual referrals submitted to the health authority between 1 April and 30 June 1991. SETTING--Merton and Sutton Health Authority. RESULTS--247 extracontractual referrals were notified to Merton and Sutton Health Authority; 83 invoices for emergency treatment and 109 elective referrals were authorised at a total cost of 190,000 pounds. Of the elective referrals, 59 were to ear, nose, and throat; orthopaedic; or general surgery departments. Local general practitioners made only two thirds of the elective referrals, at least 15 of which were made at the patient's request. Four admissions accounted for a quarter of the total cost of the emergency admissions. CONCLUSIONS--Extracontractual referrals are unpredictable in terms of both their number and their cost. They provide a necessary safeguard for patient and general practitioner choice at the price of a considerable administrative workload. The fact that these referrals are income generating for providers means that additional safeguards may be necessary to prevent abuse of the system.