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Competition is increasing referral rates

I write in respect of the 16% increase in primary care referrals to secondary care in the first quarter of 2008/9.

I believe the factors you describe are valid and real but I think you are omitting an important issue.

With Darzi practices being set up all around us we are keen to keep our patients very happy - not only in terms of access to our own services in primary care but also secondary care services.

Increasingly competitive pressure among established practices and new APMS providers will result in the gatekeeper role of GPs being eroded as 'patient power' is enhanced. GPs harbour the very real fear that Darzi practices will erode their list, and consequently income, if patients are not kept completely happy.

I openly ask if the great Lord Darzi thought of this consequence of his reforms?

Dr Michael Milner, Saltburn, Cleveland

The increase in referral rates from GP practices is continuing and many PCTs have started monitoring it and taking indirect action against the outstanding practices.

However, there are many reasons for the increase, such as the discontinuation of consultant to consultant referral, early discharge and the policy of telling the patient to go to their GP and ask for referral to speed things up. And there are a host of other players involved, such as NHS Direct, out-of-hours staff, casualty staff, pharmacists, ambulance crews and so on. Certainly, GPs should not be blamed for it.

Dr Nagy Gabriel, Ramsgate, Kent

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