Why are NHS referral management centres putting patients' health in danger?

This morning the BBC confirmed (http://www.bbc.co.uk/news/uk-england-38372332) what I was arguing in my post last week on the scandal of referral management centers. Their review of management centers shows that they are ineffective, costly and cause a delay in patient care. The febrile atmosphere surrounding the NHS about lack of resources means that the real issues can sometimes get lost. The scandal here is not CCGs managing referrals or denying patients access to treatment. It is the use of management "centers" themselves and the fact that they make the situation worse not better.

Patient referrals should be reviewed. All the evidence shows that 40% of the time, when a GP decides that referral is the next best step in the patients care they are wrong. Those wrong decisions cost patients time, money and worry. But GPs should not be excoriated for making those decisions. Theirs is an impossible task - to be experts in all areas of the ever growing encyclopaedia of human illness. The review process should be sensitive to that.

Review should be done by the very experts that the GPs are seeking help from. This would help acknowledge the difficulty of the GPs job and reassure patients that their care decisions are in the best possible hands. The reviews should not be weeks after the event like a financial audit looking for errors and mistakes. Delay simply makes review more difficult with facts and reason dulled by the distance of time. Review should occur at the moment a GP is thinking of referring.

The term “referral management” has echoes of a nation’s border control. Repelling unwanted immigrants at the door and treating all with a cold suspicion. Referrals should not be viewed in this way. They are a request to a specialist for help in the patient’s diagnosis or treatment plan. It is the gap between primary and secondary care today that means these requests are one sided. If primary and secondary care are brought together then these referral reviews can be two way discussions between local GPs and specialists. They will deliver the best care for a patient, foster mutual learning and trust in both specialists and GPs and save money. 

This different way of doing things is embedded in the new advice and guidance services offered by some hospital departments. Not only are 40% of patients saved an unnecessary trip to hospital but the remaining 60% are dealt with more quickly and effectively. CCGs and NHS Trusts need to work together to facilitate this kind of primary secondary care communication and find the right solution not the wrong one to referral management.