Curbing GP referral inflation
I have always been fascinated by the variability of individual and practice referral patterns, and many people have tried to understand this complex facet of primary care. So it was with great interest that I read in the univadis GP News service (click here) that GP referrals have risen recently. Apart from the cost implications that no doubt attract a lot of attention, there are clinical and logistical issues related to this. The causes of rising as well as variable referral rates are probably many and complex, and there is no simple answer.
However, there is no harm in speculating and I wonder what could happen if GPs had greater access to diagnostic facilities to perform investigations themselves. For example, easy access to computed tomography and magnetic resonance imaging scanning, rapid access to gastrointestinal imaging and, crucially, easy access to specialist advice without actually having to refer the patient. I feel that giving GPs more clinical support, for example, by having more specialist nurses attached to and working closely with a GP practice, could also be more effective than the current system. Perhaps a more comprehensive GP service such as this could reduce referral rates, but would this be a cost effective solution? That remains difficult to establish, but could prove to be a big issue for GP commissioning in the coming years.
Talking of referrals, also recently featured in the univadis GP News service was a report in the BMJ that GPs less often refer elderly people than their younger counterparts to secondary care services, for a similar clinical scenario (click here). Again, the reasons for this are complex but with economic pressures likely to constrain referrals, perhaps primary care will be expected to do more?
According to another BMJ report highlighted in the univadis GP News service (click here), GPs must be proactive to help return their patients to work after a period of illness. This could include suggested changes to their working environment, but are office based GPs really in a position to do this, without independent access to the workplace? And are GPs really suited for this role, or, for that matter, keen to take it on?
Dr Harry Brown, editor-in-chief
By Dr Harry Brown