Intended for healthcare professionals


Costly referral management centres fail to deliver savings

BMJ 2010; 341 doi: (Published 12 August 2010) Cite this as: BMJ 2010;341:c4351
  1. Oona Mashta
  1. 1London

    NHS referral management centres, set up to manage referrals from GPs to secondary care, which cost millions of pounds, are failing to deliver savings, the health policy think tank the King’s Fund has said.

    In some instances the centres are undermining quality by misdirecting referrals in the absence of full clinical information or by delaying access to a specialist, the research by the King’s Fund found.

    Candace Imison, deputy director of policy at the King’s Fund, said, “We found that the most interventionist management approaches from PCTs [primary care trusts], such as referral management centres, were unlikely to offer value for money and could actually increase overall costs to the NHS.”

    The report calls for GP commissioning consortiums to manage referrals through peer review and audit linked to feedback from hospital consultants.

    The recommendations come after proposals in the government’s white paper to give GPs more control over commissioning and to abolish primary care trusts and strategic health authorities (BMJ 2010;341:c3796, 14 Jul, doi:10.1136/bmj.c3796).

    The number of referrals to secondary care has risen sharply in recent years. GPs made more than nine million referrals in 2009, resulting in costs to the NHS of more than £15bn (€18bn; $24bn), says the report.

    Between 2005 and 2009 the number of referrals to hospital outpatient departments rose by 19%. Referrals from consultant to consultant rose by 39%, and other referrals rose by 41%.

    The study involved literature reviews, case study analysis, and interviews with trust personnel working in referral management. It also looked at the referral patterns of 21 primary care trusts with the most active referral management strategies.

    Primary care trusts have adopted different strategies to improve the quality and effectiveness of referrals, including referral management centres, clinical triage, and assessment services. These often offer GPs financial incentives or clinical guidelines to try to improve quality and to reduce costs by reducing unnecessary and inappropriate referrals.

    The report found that although half of the trusts believed that their referral management schemes had reduced the demand for secondary care, those using active referral management strategies, such as referral management centres, were in fact no more likely to achieve a reduction than other trusts.

    The report is part of a series in a King’s Fund programme aiming to help the NHS respond to the challenge of unprecedented budget constraints while improving the quality and experiences of care and meeting growing demand for health care.

    It recommends seven evidence based principles for commissioners to use to identify suitable strategies for improving the quality and appropriateness of referrals.

    Ms Imison said, “All future GP commissioning consortia will need to consider referral management options, so we’re pleased that our analysis of what works can be used by commissioners now and in the future to determine which approaches could deliver cost and quality benefits within their local health economy.”


    Cite this as: BMJ 2010;341:c4351


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