I am concerned by Hawkes editorial on the variability on GP referral rate for suspected cancer. The quote from Mick Peake “However, the range of the variation is so wide that, at the extremes, it probably reflects differing standards of care” must be vigorously challenged. Those of us the sharp end of general practice are aware of these differences, but hesitate to use such data as true performance indicators. We have known for a long time, that those who refer the most tend to have the most experience in the area to which they refer 1. Any suggestion therefore that a high referrer is performing in a “substandard” way does not add up. However what about the low referrer?

At our surgery we carry out peer group analysis of individual referrals. Without looking at individual cases and outcomes, any further discussion on performance related to referral rate is meaningless.

James Mumford

Reference

Reynolds GA, Chitnis JG, Roland MO. General Practitioner outpatient referrals: do good doctors refer more? BMJ 1991; 302: 1250

Competing interests: None declared