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Referral management centres ‘cost £20 per outpatient’

Use of referral management centres costs at least £20 per outpatient attendance and can present a risk to quality of care, a leading NHS researcher has warned.


Candace Imison, deputy director of policy at the King´s Fund told a recent conference : ‘My calculation is that [referral management centres] probably cost about £20 per outpatient attendance. That’s a hell of a overhead to get back through referring away other activity.’


She added: ‘We came across some incredibly weak clinical governance frameworks for these centres and it really struck me how many of these things that sprout up outside of hospital – have we really thought anout the clinical issues.


‘So we had 20 per cent of letters going astray, people going on hols with no-one to subsitute so referrals just sat  and waited for x number of weeks. It was extraordinary. The assumption was that other governance mechanisms would take care of them.’


Last year, the King’s Fund published research suggesting the centres were not cost-effective.

The qualitative study involved a literature review, interviews with PCT staff, four case studies and analysis of outpatient data.


It concluded that peer review and audit by clinical commissioning groups was likely to be more cost- and clinically-effective than blanket use of referral management centres introduced by many PCTs to slash spending.


Ms Imison´s remarks followed criticism of referral management earlier this year from RCGP chair Dr Clare Gerada. Dr Gerada told the health committee inquiry on commissioning in February that the growth in compulsory referral management centres across the country was causing ‘tensions’.



Ms Imison told the NHS Confederation conference’ I also got really, really vehement antagonism towards it from some of the GPs I spoke to who felt it was totally deprofessionalising them and distancing them from their secondary care colleagues. Some talked of them making them lazy – they would just send everything up and see what came back down.’




Dr Johnny Marshall, chair of the National Association of Primary Care and of United Commissioning in Buckinghamshire said his commissiong group and others in NHS South Central SHA were peer reviewing referrals which was much more cost-effective and better for patient care: ‘We´re not using referral management centres as an agreed pathway at all. There is monitoring of the pathway, but its done from an educational perspective.



‘Good care means putting the right patient in the right place at the right time with the right consultant. We can compare within practices and between practices and that way you drive up the quality of care.



‘It´s a lot less expensive this way – far less than £20 per attendance. Any option you look at has to be good value for money