It is the low referrers that bother me
Any referral management process that tries to limit referrals for non-clinical reasons is both unsafe and unethical ('GP leaders ousted following private firm's report').
Furthermore, should a patient die as the result of a failure to refer it is possible that a case could be successfully brought under the Corporate Manslaughter Act if it could be shown that the failure to refer was the direct result of an organisational policy.
From a specialist viewpoint - and I audited this some 20 years ago - I'm not particularly worried about high referrers; it's the low referrers that really concern me. I think Hillingdon is taking an enormous risk with this policy and GPs should make it clear, if they are effectively forced to comply, that they do so under protest.
From Dr Andrew Bamji, Queen Mary's Hospital, Sidcup, Kent