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Commissioning dilemma: Referral management is harming your patients

A significant minority of your referrals are returned to you via the commissioning groups referral management process – even after appeal that, for example, the patient was significantly distressed or insisting on referral. You feel the process is starting to impact on your duty, as a doctor, to refer when appropriate. What action do you take?

A significant minority of your referrals are returned to you via the commissioning groups referral management process – even after appeal that, for example, the patient was significantly distressed or insisting on referral. You feel the process is starting to impact on your duty, as a doctor, to refer when appropriate. What action do you take?

As you have identified, the GMC is clear that "good clinical care must include … referring a patient to another practitioner, when this is in the patient's best interests". It is extremely worrying if referrals, that appear to be in the best interests of the patient, are being returned. You may wish to consider discussing the referrals with a colleague to identify if any have been inappropriate. This would allow you to identify any training/development needs that you might have.

Once you feel confident that there are returned referrals which are clearly in the patients' best interests and, as such, entirely appropriate, you would need to raise your concerns regarding the management process. Good Medical Practice states "if you have good reason to think that patient safety is or may be seriously compromised by … other resources, policies or systems, you should … draw the matter to the attention of your employing or contracting body".

Raising your concerns with the PCT can be a daunting process and you may wish to consider identifying other doctors within local practices who have had similar experiences. Also, it could be valuable to raise this issue with the Local Medical Committee. Presentation of your concerns, as a group, is an effective and supportive way to fulfil your duty and ensure that your patients receive care that is in their best interests.

Dr Sarah Cornock is medicolegal adviser at the Medical Protection Society

Commissioning Dilemma

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