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Gold, incentives and meh

How we reduced our referral rates by 46%

Dr Michelle Sinclair explains how GP education, cross-referral, targeting locums and use of non-GP alternatives dramatically cut her practice’s referrals

The problem

As with all general practices, we were faced with  inexorable demands to reduce costs, with a growing list of audits, reviews and a feeling of ‘big brother’ watching us.  

Due to a partner retiring in July 2009, over the latter months of 2009 and  then 2010, we started using more locums. In April 2010 to April 2011, our practice steadily climbed to become the highest referring practice in our locality of 22, reaching a staggering 34.8% above target levels compared to the average of an 11% increase amongst other practices.  

What we did

Spurred on  not only by  increasing demands to reduce costs, to audit, review and report, the decision was taken to implement a referral plan that included regular weekly indepth meetings with the practice’s new business and practice manager, educational  in-house sessions, cross-referral to partners with more expertise and heightened awareness of referral statistics.

High-referring specialities were targeted for reduction and subjected to weekly scrutiny until levels reduced significantly.

We monitored the referral activities of our locums and more importantly, educated them on the practice’s plan. We stopped working with any that were persistently high referrers and who ignored our directives.  

We also actively encouraged and educated our patient population as to the availability of alternatives to the lengthy NHS waiting times: complementary private therapists,  counsellors, osteopaths, a physiotherapist, hypnotherapist, reflexologist, and podiatrist were all signposted through the surgery.  

Challenges

The more militant locums simply wanted their hours and were not interested in reducing practice costs and target levels.  

The weekly reviews increased our manager’s workload, with many hours spent scrutinising target data received from our CCG, making comparisons, reviewing and changing our  referring habits, educating ourselves to scrutinse data, and implementing changes to individual practice.

Outcomes

Our referral levels were increasing annually with some year on year comparative figures showing us as high as +28% compared to the same time in the previous year.  From April 2011 to March 2012 we had reached an overall total for year of +3% above target levels.  However by the following March 2013, in just one year we had significantly reduced our overall total for the year to -18%.

As we surpassed our target levels, others in our locality started to question what was going on. Was the data incorrect, were we using out of area services, just what exactly was the practice doing to have achieved such a dramatic reduction?  We were eventually approached by our CCG and asked if we were willing to become a case study, to share our tactics with neighbouring practices.  

The future

Despite our success, for 2013/2014, the practice still was given higher targets to reach, with the same pressures.  

Sadly our success did not see us rewarded in any way. We have the same cuts, the same financial pressures of doing more for less, but we have achieved the supposedly impossible and believe that these methods for now are sustainable for the immediate future.  

Dr Michelle Sinclair is a GP in Fleet, Hampshire.

Readers' comments (15)

  • I don't see any discussion in this article about whether the "excessive" referrals were in fact clinically appropriate, and whether there might be a reason that certain specialties have high rates of referrals. I see only a focus on targets.

    Perhaps the locums who ignored your directives were the ones acting more appropriately in their patients' interests.

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  • Have you checked your cancer survival rates?

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  • It really is not worth all the time and effort doing this. Our f

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  • Our first duty is to the patient in front of us.

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  • Referring to complementary therapy? Oh, please

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