Patients are not commodities

Referral management centres have been set up in an attempt to control the flow of patients from generalist to specialist services.1 Those proposing and creating such centres seem to view a referral as a simple administrative transaction, whereas those working in primary care know that a successful referral is a much more complex and challenging phenomenon.

Referrals cannot be understood simply in terms of demand. Many patients have to be persuaded to accept referrals and this requires painstaking and careful negotiation within which wide-ranging fears are explored and discussed. The referral process must be able to respond not only to expressed demand but also to unexpressed need.

Referrals occur either because the diagnosis …