Intended for healthcare professionals

Rapid response to:


Defending referrals between consultants

BMJ 2006; 332 doi: (Published 09 February 2006) Cite this as: BMJ 2006;332:371

Rapid Response:

Consultant to consultant referrals are funded


Dr Goodman correctly states that consultant to consultant referrals
are not part of the monitoring of waiting time standards for trusts and
therefore may be given less priority by trust managers. However, he is
mistaken in his assertion that consultant to consultant referrals are not
funded and that this may also influence how managers behave. Under payment
by results all out-patient attendances are charged at tariff. First out-
patient appointments have a higher tariff than follow-up attendances but
the source of the referral is not relevant. Primary care trusts (PCTs)
therefore fund trusts for consultant to consultant referrals in exactly
the same way as they do for GP referrals. It is this issue that is driving
some PCTs to try to get a better grip on referrals between consultants.

There will always be perverse incentives in a bureaucracy as complex
as the NHS, but it is important to understand the rules of the system
before ascribing possible motives to others.

Competing interests:
None declared

Competing interests: No competing interests

14 February 2006
Tim E P Davies
Director of Public Health
South Worcestershire PCT B50 4NT