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PCT clampdowns on GP referrals 'inappropriate'

PCT schemes to clamp down on GPs' rates of hospital admission are inappropriate and based on a misunderstanding of general practice, research has concluded.

Hospital admissions are far more likely to be related to levels of deprivation than to any individual feature of the referring practice.

The study by researchers at the University of Bristol, covering all general practices in England from 2005 to 2007, found admissions for conditions managed by primary care were 50% higher in areas of high deprivation than in less deprived areas.

41208692By contrast practice variables – such as QOF achievement and practice size – had only a limited effect on admissions.

The researchers warned their findings questioned the proliferation of ‘tier 2' services to limit GP referrals, saying PCTs should focus instead on public health interventions.

Dr Sarah Purdy, consultant senior lecturer at the University of Bristol, said the study detailed for the first time the effect deprivation had on health outcomes and why referrals management schemes were rarely effective.

‘To try to reduce referrals - because variation across practices is more about the population they serve than the practices themselves - is not that effective.

‘A lot of it is about how people live their lives, rather than what their GPs do. It shows where you live, the support you have, your level of literacy, whether you speak English, whether you have the money to get to the GP surgery all play a large part in how those conditions present,' she said.

Dr Kate O'Donnell, senior lecturer in primary care at the University of Glasgow, said the study supported other research showing practice-related factors could only explain around half the variation in referral rates between practices.

‘We have to encourage policy makers to move away from such simplistic notions of reducing admissions or referrals to a particular level,' she said.

The research comes as GP referrals are under particular scrutiny, with a 16% increase in referrals in the first quarter of 2008/09 against the same period last year.

Dr David Jenner, PBC lead at the NHS Alliance and a GP in Cullompton, said GP referral management schemes did not work if they were forced on GPs.

‘Referral management schemes are just a delay in the system - unless there are suitable community options that they can be signposted to and patients often prefer.'

Hospital corridor Pressure on GP referrals

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