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The dangers of referral management centres in the UK

17th February 2017 Print

A significant number of healthcare systems throughout the world face certain struggles brought on by bureaucracy, but none quite as evident as the UK’s NHS. Over the last 20 years, the national health system tasked with providing care to a growing patient population has experienced setbacks, including oppressive costs, miscommunication between doctors and patients, and instances of poor-quality care due to understaffing and reduces clinic hours. The pressing need for change within the system has come to the forefront of discussions throughout various patient safety and advocacy groups, the UK government, and the healthcare system itself. Interesting solutions have been implemented to scale back to cost burden placed on hospitals and clinics, including reforms for how patient referrals are managed. 

In the last decade, referral management centres have become a significant piece of the healthcare system in the UK. These centres are used in an effort to reduce the number of referrals sent from primary care doctors to specialists or outpatient hospital services for patients who may need a different type or additional care. Referral management centres add a layer of bureaucracy in the system, intended to put a stop to unnecessary referrals that ultimately place an added cost burden on the healthcare network. While referral management centres make sense in theory, their practical use and potential cost saving efforts are in the spotlight for all the wrong reasons. 

The BMJ Investigation

The addition of referral management centres to the UK healthcare system has been under scrutiny for some time. The British Medical Journal took on the challenge of determining whether or not these centres have a place in healthcare, based on the cost reduction they are able to generate for clinics, hospitals, and the government. Through a recent Freedom of Information request to all 211 clinical commissioning groups (CCGs) throughout the UK, the BMJ was able to determine the truth about the viability of referral management centres as they are structured currently. 

Out of the CCGs who responded to the BMJ’s request for information, 61% revealed that a referral management centre was used in varying degrees to help evaluate the patient’s need for a referral to a hospital or specialist. Of the 61%, nearly one-third commented that a private centre was used, while 29% used in-house services and 11% used a centre provided by an NHS trust. Not all CCGs provided detailed costs of operations, as some have not tracked that data, but of the 69% that did, it was uncovered that more than £57 million had been spent on referral programs since April 2013. Given the high cost of employing referral management centres, one would hope a cost reduction would be in the wings. Unfortunately, only 14% had data to prove a reduction in costs associated with referrals, and another 12% showed no cost savings whatsoever. 

Patient Safety and Referral Management

According to Eddie Chaloner, a vascular surgeon at a varicose vein clinic in the UK, the inability to show the effectiveness of referral management centres has a direct impact on patient health. Chaloner states, “Clinical commissioning groups began to write their own guidelines about what patients’ primary care providers were allowed to refer to specialists. In my own specialty, the rules on varicose vein referrals were changed so that only the most serious cases were allowed to be referred. Uncomplicated varicose veins were not allowed to be seen in a hospital, and the letters are rejected by the referral management centre and sent back to the primary provider.” When this takes place for patients who truly need expert care in a specialty setting, there is an added cost burden placed on the healthcare system, not to mention a direct negative impact on the patient’s well-being. Chaloner continues, “Non-medically qualified people are interfering with communications between doctors, posing a threat to long-term patient outcomes when referral management centres are used but not fully evaluated.”

A delayed diagnosis or treatment can be detrimental to the health of a patient, and referral management centres make that a reality throughout clinical commissioning groups in the UK. If there was data to back up claims that these centres saved the excessive cost of unnecessary referrals to specialists or outpatient hospitals, their existence and widespread use may be justifiable. Unfortunately, referral management centres are adding to the bureaucracy problem with the country’s health system – a cost passed down to patients and their families.

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