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Up to one quarter of GP referrals ‘avoidable’

Exclusive Up to 25% of GP referrals could be avoided through a combination of better signposting, education, pathway redesign and use of technologies, according to the authors of an audit of referrals carried out by a CCG.

The audit – led by two GPs at NHS Southern Derbyshire CCG – found 15% of GP referrals were inappropriate and could have been dealt with in primary care and another 8% were made before the condition had been fully explored, while a further 1% of referrals were classed as ‘bonkers’ by the authors.

However, they concluded that these avoidable referrals were as a result of ‘busy practices’.

Dr Komal Raj and Dr Callum McLean carried out the audit, in which all 20 practices in the locality sent in GP referral letters for the whole of November 2013 – a total of 1,995 letters weighing 42 kg.

As well as the 15% of inappropriate referrals, and 8% of early referrals, the audit also found 7% were were re-referrals, whereby patients had to be referred again after being wrongly discharged back to the GP.

The 1% of ‘bonkers’ referrals were ‘without focus, value or common sense’ – but these were most commonly the result of ‘proxy’ referrals whereby GPs were told by secondary care to make the referral.

The audit also revealed very marked variation in referrals among practices – with a 400% variation in the total number of referrals and a 2,000% variation in inappropriate referrals – which Dr Raj said showed a lot of the problems were down to some practices struggling with demand.

Dr Raj said: ‘I think it’s just busy practices, they are just so busy they have not looked at different ways to see patients or run their practices, and the end result is you get more referrals and admissions.’

He stressed most of the problems were due to poor communications or pathways and lack of education, and that the aim of the audit was to demonstrate where improvements could be made and put better systems and support in place.

Dr Raj added: ‘It’s not a case of telling GPs off, to say what they are doing wrong, because we’re all really busy and I know what happens, you’re busy, you’ve got a really full clinic and you just end up referring them.

‘What we are trying to do is find a solution to actually support GPs and practices. So one thing we’re looking at it is sending a GP into the practice, not in terms of simple triage but building up a relationship with the practice and looking not only at referrals but if there are issues with visiting rates, IT and all sorts of things.’

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