Intended for healthcare professionals

Analysis And Comment Health policy

Referral management centres: promising innovations or Trojan horses?

BMJ 2006; 332 doi: (Published 06 April 2006) Cite this as: BMJ 2006;332:844


I have no real objections to my referrals being triaged by
clinicians. I am under no illusions that referral is used as an "option"
for GPs and that we use it sometimes inappropriately just to be seen to be
doing something. Of course medico-legally it is a powerful defence and I
know of many GPs who will refer, expecting little from the referral but
often the guidelines advise it. Life is increasingly full of
contradictions and health care abounds with them. Try and be a
responsible, good GP who refers less and you might end up with a case
going wrong and bring on all the opprobrium meant for the "bad doctor". Of
course the "bad" doctor is happy as he has referred. GPs know they will
get little support from anyone other than trusted colleagues when things
go wrong and perhaps if the system was less harsh in those cases,
referrals would reduce.
I think GPs could reduce referrals by creating their own referral centres
within their practices so that all expertise could be pooled. I have tried
to get a virtual referral forum going in my practice with no success. The
abiding culture is to tell the patient that you are referring and move
onto the next case and this mitigates against consulting colleagues before
you make the referral. A small culture change whereby GPs discussed all
referrals before sending a request could have a major impact.

Competing interests:
None declared

Competing interests: No competing interests

10 April 2006
Graeme Mackenzie
Whitehaven CA28 7RG