Dr Jonathan Serjeant's open letter makes important points about the current poor experience of many patients referred through conventional routes.
The evidence from research is clear that there is significant scope for referral processes to be improved, and we are aware that the referral service offered by Brighton Integrated Care Service explicitly aims to support patients through this process and works to high governance standards.
Sadly, the research we undertook at locations across England found that there are referral management services that do not work to these standards.
The points made recently at the NHS Confederation conference were designed to highlight some of the risks. In our report we make it clear that we found examples of both good and bad practice in referral management.
The estimate that referral management costs £23 per referral was based on a centre that had been working for several years.
However, our view is that further work is needed to assess the cost-effectiveness of referral management services.
From Candace Imison
Deputy director of policy, King's Fund