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Clampdown feared over 10-fold range in referrals

Referral rates vary 10-fold between practices ­ and clinical and population differences cannot justify why some GPs refer so many patients.

A major study by Government-funded researchers, covering 1.16 million patients in 202 practices, found annual referral rates ranged from 2.4 to 24.4 per cent of patients.

Only 1.3 per cent of the variation could be explained by differences in the age, sex and morbidity of the patients in the practice.

The findings, presented to the Society for Academic Primary Care annual conference last month, could stoke Government pressure to drive down GP referrals.

The NHS Modernisation Agency is urging PCTs to monitor individual GPs' referral rates quarterly and identify 'outliers' in a bid to

meet the NHS Plan target

of a maximum three-month wait for all hospital treatment by 2005.

But the researchers said it would be unfair to clamp down on individual GPs. They found the vast majority of referrals were appropriate, even in high-referring practices.

Study leader Caoimhe O'Sullivan, a Department of Health-funded medical statistician at University College London Hospitals NHS Trust, said: 'People are being referred for the right reasons and when they need to be.'

Professor Martin Roland, director of the National Primary Care Research and Development Centre in Manchester, said: 'We know from past research you can't make any clear link between rate of referral and the quality of care a GP is giving. If I were a patient I would be more concerned about GPs with low rates of referral.'

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