Intended for healthcare professionals


Referral from primary to secondary care

BMJ 2010; 341 doi: (Published 01 December 2010) Cite this as: BMJ 2010;341:c6175
  1. Moyez Jiwa, professor of health innovation
  1. 1Curtin Health Innovation Research Institute, Perth, WA 6845, Australia
  1. m.jiwa{at}

Older and more deprived patients remain at a disadvantage

Only a minority of people require hospital services, most people treat themselves or consult a generalist.1 General practitioners, who are usually the first point of contact for patients, must decide which patients to refer to secondary care.2 We do not know the extent to which people who are denied access to specialist services by the gatekeeper are disadvantaged. Some may be denied timely access to experts who are best placed to help. Alternatively, others may be harmed by unnecessary diagnostic tests and interventions. Therefore, the appropriate referral of cases to secondary care has economic, quality, and safety ramifications that resonate across the health sector and the globe. In light of this, the linked study by McBride and colleagues (doi:10.1136/bmj.c6267), presenting referral data for 130 000 British patients, is useful.3

St Bartholomew’s Hospital, London/Science Photo Library

A conceptual framework that could be used to analyse this study was published by Glasziou and Haynes.4 It proposes that, for patients to receive …

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