Utilisation Review of Specialist Referrals by GPs
Referrals to Secondary Care Specialists by GPs has been a concern for Primary Care Trusts (PCTs), and now Practice Based Commissioning Groups (PBC) for some time. Patterns in first to follow-up referrals have been increasing over time, and there has been interest in determining whether the referrals are clinically appropriate, what referrals could be managed in Primary Care with current or additional resources. A Utilization Review of referrals has been conducted in PCTs by Tribal/Model Advice DC Consulting specifically to identify:
- What steps the GP took to diagnose and treat signs, symptoms and complaints of patients related to non-life threatening conditions prior to initiating a referral to a specialist consultant
- The reason for the referral to a specialist from the GP
- What alternative care services are currently available or could be made available at a lesser cost but clinically relevant to the patients conditions that would reduce the reliance of the GP on specialist consultant services
- What other root causes there may be for the increasing pattern of GP to specialist consultant referrals
The reviews are conducted by nurses who review referral information in the Surgery, specifically the information in randomly selected patient records specific to referrals generated by the GP. The reviews are focused on specialties based on the total number of referrals for each specialty. The reviewers screen all information in the patient’s case note sets to answer specific queries about the condition of the patient causing the referral, and other items as identified above. Generally, depending on the number of reviews to be done at a surgery, one surgery can be audited in 1-2 work days.
Results of previous reviews has generated data that reveals an opportunity to reduce referrals to secondary care specialists by 26-30% through expansion or development of specific primary care services that GPs could utilise as an alternative to secondary care referrals.