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Commissioning Dilemma – High referral rates in neighbouring practice

Your neighbouring practice has a high referral rate, and while it protests that this is a product of its patient population, you know its GPs have a low threshold for referral. Should you take this up with your consortium? Dr Charles Alessi advises

Relationships between practices within consortia and their interdependency are at the heart of the new reforms, the behaviour of one practice can affect the fate of others within the consortium. The quality payments are going to be paid into the consortia and thus should the behaviour of one alter the payment for others, this will inevitably lead to tension. Therefore it is in everyone's interest that this matter is dealt with before it escalates.

I would suggest:

• Ensuring the consortium has a preliminary conversation with the practice concerned to ensure they are aware of the link between their behaviour and the rest of the practices

• Putting pressure on the consortium to involve public health to investigate the population of the affected practice to demonstrate what is the makeup of its demography and its health needs.

• Offering assistance to the practice in the management of referrals – there are now tried and tested systems that have been trailed, around internal practice referral management, which could be implemented. These could include a more corporate approach to the referral process, including weekly referral meetings.

The very vast majority of practices are willing to accept help and are also very keen to ensure they are seen as a quality practice, pulling their weight and seen to be doing so. This all helps to ensure a solution is reached.

Dr Charles Alessi is a GP in Kingston-upon-Thames, Surrey, chair of the Kingston Pathfinder Consortium, and executive member of the National Association of Primary Care

Dr Charles Alessi