Referrals between consultants: Consultant referrals are funded

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7539.490-b (Published 23 February 2006) Cite this as: BMJ 2006;332:490
  1. Tim E P Davies, director of public health (tep.davies{at}btinternet.com)
  1. South Worcestershire Primary Care Trust, Worcester WR4 9RW

    EDITOR—Goodman correctly says that consultant to consultant referrals are not part of the monitoring of waiting time standards for trusts and therefore may be given less priority by trust managers.1 However, he is mistaken in his assertion that consultant to consultant referrals are not funded and that this may also influence how managers behave.

    Under payment by results, all outpatient attendances are charged at tariff. First outpatient appointments have a higher tariff than follow-up attendances, but the source of the referral is not relevant. Primary care trusts therefore fund trusts for consultant to consultant referrals in exactly the same way as they do for general practitioners' referrals. It is this issue that is driving some primary care trusts to try to get a better grip on referrals between consultants.

    There will always be perverse incentives in a bureaucracy as complex as the NHS, but it is important to understand the rules of the system before ascribing possible motives to others.


    • Competing interests None declared.


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