There is a much more effective way of reducing referrals by sharing the burden of referral decision making. Encouraging pre referral consultations between GPs and specialists via phone or email increases the available knowledge at the time of referral. Not only does this improve decision making in real time but it builds relationships and provides "real-world" case based learning opportunities for GPs that will drive long term benefits. Precision of referrals would also improve with referrals being made, if needed, to relevant clinics straight off the bat. Shared referral decision making recognises that referral decisions are not always straightforward but that the best way of making the "right" referral is for two professionals, one with deep knowledge of the patient and one with domain expertise to discuss it together and share the responsibility for that decision. Effectively the decision to refer becomes a mutual agreement between GP and specialist, together with the patient, that they need to cross from primary care into secondary care but both sides agree that this is required and that it's happening at the right time.