Stemming the referral tide

10 years of raising patient expectations for political gain does not seem to have been considered as a cause? When GPs are judged (and partly paid) by patient satisfaction, raising patient demands on GPs will inevitably result in referral onwards. When will someone in power have the moral courage to say that we cannot afford your gold standard treatment when we only have brass in our pockets to pay for it! Stop promising the earth and expecting a cash-limited service to provide it because every change made costs us money to plan and implement it as well as deliver it.

Rather than trying to insert a bureaucratic filter a much better solution is to provide clinicians with a tool to do this job better. We ran a trial at 4 practices in SW London during 2010 of the Isabel diagnosis and referral decision support system (http://www.isabelhealthcare.com) to see the effect on referrals.

In 29% of cases where it was used the GP's said that they no longer felt the need to refer the patient and in 36% of cases where they did have to refer they said that it helped them refer more appropriately. The abstract of this study was presented at an international conference and you can access it from this link: http://smdm.confex.com/smdm/2010on/webprogram/Paper5940.html

As a web based tool this is considerably cheaper, more effective and more sustainable than the elaborate solutions that have been tried and shown not to work as described in your article.

Disclosure: I am the founder of Isabel Healthcare