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What difference will the Referral Management System make to our area?

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The recent announcement of funding levels for CCGs found the four areas of North Yorkshire, formerly in the bottom 6% of  PCT’s, happily climbing the ladder in terms of funding.

Perhaps year on year overspends and historic debt have been noted and some adjustment made. The Vale of York is, however, bottom of the four areas (Hambleton and Richmondshire, Harrogate and District, and Scarborough Whitby Ryedale) while facing the biggest financial challenge.

The Vale of York is deemed to have special problems with heavy reliance geographically on a foundation trust that is economically strong and (rightly or wrongly) in some quarters considered to be significantly over-trading. Consequently the CCG has significant conditions associated with its authorisation and we’re facing urgent measures looking for early results.

One of these measures which the CCG wishes to introduce in very short order is a Referral Management Service (RMS). There’s the perception of an urgent need to grip the referral data, attempt to address variation in referral patterns and ensure thresholds are adhered to: all understandable.

This blogger attended a meeting where apparently successful RMS from other areas such as Cornwall and the Scilly Isles, and Manchester were presented as creating savings with very little obstruction to referrals and good outcomes all round, so I would very much like to hear from service users whether this was a balanced presentation.

The BMA has issued guidance concerning RMS with attention to the principles of services, clinician responsibility during the management process and concerns with lack of involvement of providing clinicians in diagnosis and consent of patients.

Unfortunately I predict a big battle for the CCG in convincing member practices to accept the RMS. It will be an interesting test case of the responsiveness and flexibility within the new management system and would go some way to answering the question of who really makes up the CCG: a management board or constituent practices? Where RMS is concerned, the fear is that this level of performance management will create confusion, more work for GPs, less choice and delays for patients and ultimately infringe clinical freedom.

If the drive for RMS is genuinely to obtain high quality accurate data to enable activity analysis and management then a compromise might be achieved. However, those of us who’ve been around for a while are slightly more suspicious that the RMS has been identified centrally as a priority for our area, and is not really up for negotiation – but rather comes in the package of conditions for authorisation.

Has your area had the help of a Referral Management System? Leave your remarks in the comments if so.

Dr Andy Field is a GP in York. He is also a member of North Yorkshire LMC but this article does not reflect the views of the LMC.

Readers' comments (2)

  • In Cumbria we went down the route of providing funded referral support for every practice akin to our very successful prescribing support mechanism. We took this route because of unhappiness from local GPs at the prospect of losing the right of direct referral.

    I now work for an acute trust and any potential "over-trading" in follow-ups is contractually capped at the 75th centile. We are currently embarking on a joint primary and secondary care clinical review of this policy specialty by specialty.

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  • Interesting, as a Manchester resident I was caught up in a RMS problem. My son needed speech therapy referral but the RMS insisted that he should go to ENT first even though GP agreed that it wasn't necessary but felt unable to challenge. GP however, felt that referral from ENT to speech therapy services likely to succeed. Horrendous delays (delay to ENT, then delay to speech therapy), an ENT surgeon infuriated that we had wasted her time as clearly it wasn't needed. My son felt humiliated (even more - as he had difficulty communicating anyway). Not impressed.

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