Demystifying GP referrals
The decision making processes of referral can sometimes be shrouded in mystery, particularly when referring from primary care to secondary care. Referral rates among individual GPs or practices can vary quite widely, even within a locality, for which there are numerous reasons. Knowledge, confidence, patient expectations and doctor management of uncertainty are just some of the complex factors that come into play. Referrals also attract interest from the corridors of power - over-referring costs a lot of money, while under-referring may be costly to patients in terms of health and well being. So it was with great interest that I read in the univadis GP news service (click here) that NICE (the National Institute for Health and Clinical Excellence) has created a referral advice database, based on the guidance it has already published.
Now this is a significant step forwards in trying to create order in an awkward area and well done to NICE. However, it is not always easy to codify what a patient's problems are and then follow an algorithm to put the patient into the correct referral pathway. Patients don't always present with easy to categorise symptoms or signs and so clinical problems are not always easy to slot neatly into a specific compartment. Even if they do, the evidence base may not always be solid enough to guide a practitioner into making the optimum decision. So within all these diagnostic doubts, a doctor has to make a decision sometimes based on inconclusive evidence and be able to spot important pathology early. Despite all this, the NICE database is a good start and hopefully a foundation to build better and more accurate decision making tools.
Meanwhile, in the government's Comprehensive Spending Review announced last week, plans to abolish prescription charges for people who have long-term conditions have been dropped. Other changes have happened as well (click here). The NHS has been more fortunate than some other government departments facing the axe on expenditure. Even so, public services and the NHS are going to face some tough financial problems over the next few years and no doubt GPs will be in the front line of this.
And elsewhere in the news… Aspirin is an amazing drug. Despite being around for some time it continues to find new roles. According to the Univadis GP news service (click here), another such role may be in preventing cancer of the bowel from developing in some people. This begs the question, what other drugs do we have at the moment that may have beneficial properties we don't yet appreciate?
Dr Harry Brown, editor-in-chief
By Dr Harry Brown