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

Managing the referral system is a good thing, despite the current shortfalls.

I think the Davies and Elwin article was careful not to come down too
heavily on the referral management system, but managed cleverly to warn
clinicians of the impending perils of such a system (in the absence of
evidence). It is difficult to say whether the referral management centre
will be more cost effective or more beneficial to patients, and I do agree
that pragmatic research is needed to look at before and after. So take
heed all those with plans to join the band wagon.

However, it is fair to say that in areas where the referral
management system has been introduced in primary care, it was done because
the healthcare delivery in terms of accessibility to specialists care were
so diabolical, that something had to be done. Healthcare expectations are
sky high, and health is now big business. It's only fair that somebody
other than a full time clinician have a say on how the task payer's money
is spent (hence managers).

From a Musculoskeletal Physiotherapist view point; there is a lot we
can do to help. Our involvement in this referral management has not
occurred by chance, but by recognition and recommendation of many senior
clinicians within the healthcare service (by virtue of our experiences
working with hospital consultants and GPs in private practices). I am sure
that if the referral management centres are manned by appropriate
clinicians there will be no need to worry about the care the patient will
get (Joint protocols can be agreed by all clinicians).

Better still, if the referral management system allows for closer
access to hospital specialists guided by an agreed pathway, then the
patient can be directed to the right services at the right time, hopefully
in a more cost effective and clinically efficient manner (common evidence
based pathways can be agreed by all clinician and issues of legality
addressed as a group).

The GPs in my view are still the main gatekeepers between the general
public and the specialists. This unique system has worked very well for
decades. But, despite new technologies, more doctors, new hospitals, etc,
accessibility, to care was deteriorating. For me, now is the time to look
at how refrrals can be better managed.

Competing interests:
None declared

Competing interests: No competing interests

19 April 2006
Billy A Fashanu
Consultant Physiotherapist
Southend Hospital NHS Trust SS0 0RY