New week, new NHS crisis. Despite the current crush in hospitals, NHS areas using Referral Management Centres to limit unnecessary referrals have been accused of getting “between the GP and patient treatment”.
The criticism, originally voiced by the BMA, was investigated by the BBC and reported on current affairs program, Inside Out. It seemed to conclude that money is being put ahead of patient care and that Referral Management Centres add nothing other than bureaucratic delays. To quote Chaand Nagpaul, “It’s either administrative or not necessary for the patient. It’s completely unacceptable. Performance seems to be related to blocking referrals rather than patient care”.
In fact, questions about the effectiveness of Referral Management Centres were raised in 2010 by the King’s Fund. As they quoted: “We do not know whether referral management centres will increase or decrease risk, efficiency or choice, and little research evidence exists to support predictions of performance… These centres have appeared overnight in an evidence-free zone“. So they investigated.
Their analysis was sobering: although the King’s Fund feel RMCs may deliver some benefits, these are arguably outweighed by a list of weaknesses:
- Might increase overall costs
- Might demotivate local GPs
- Might misdirect referrals (in the absence of full clinical information)
- Might create a barrier to closer working between GPs and consultants
- Might delay or lose referrals (in the absence of robust governance)
So where does this leave commissioners? CCGs we speak with are reporting annual growth in referral volumes as high as 6%. In the absence of considerable budget hikes, they need to act to ensure that the referrals that are made are:
- clinically necessary
- directed to the right facility; and
- compliant with local policy / guidance.
If Referral Management Centres aren’t the solution, what is? The answer, in our opinion, is the 3 following approaches in combination:
- To start with, providing GPs with comprehensive local guidelines and support using them. Support tools such as the well-known “Map of Medicine” allow GPs to make certain decisions supported by a robust process.
- Where input from a specialist might help, our own experience shows that provision of a local Advice & Guidance service is a powerful tool for ensuring that referrals are clinically necessary – 68% of calls made to Consultant Connect result in the patient avoiding an unnecessary trip to hospital (and the GP having to write out an unnecessary referral).
- Finally, if a referral is made, the King’s Fund analysis concluded that a “strategy built around peer review and audit, supported by consultant feedback, with clear referral criteria and evidence-based guidelines is most likely to be both cost- and clinically-effective“. This approach specifically doesn’t reject referrals after involvement from other reviewing clinicians, meaning that patient treatment is not delayed. Instead, it relies on reviewing referrals after the fact and the sharing of local expertise and best practice to drive improvement.
What each of these approaches have in common is that they empower the GP to make the right decision for the patient without worrying that their decision will be overruled. As well as being cost-effective, the constructive, collaborative environment promoted by the above approaches is likely to be more productive for clinicians and good for healthcare.
If you would like a demonstration of how Consultant Connect can help offer an Advice & Guidance service for GPs in your local area, please call us on 01865 261467 or email firstname.lastname@example.org