Unnecessary Obstacles to Referred Patient Care in the UK
The use of referral management centres has been on the rise over the last five years throughout the UK’s healthcare system, with a notable 10-fold increase across nearly all clinical commissioning groups. Previously, referrals were created by primary care doctors for patients who needed specialty or advanced hospital treatment not available in a clinic setting. These referrals were then sent to the accepting facility or specialist so that the patient could receive the care necessary to improve or sustain a certain level of well-being. However, referrals are not always a necessary part of patient care, and thus referral management centres were employed around the country to reduce the number of unnecessary referrals sent through the system.
Referral management centres are meant to review incoming referrals from primary care doctors, ultimately approving or denying each request based on a pre-established set of requirements and guidelines. When referrals are deemed frivolous, patients are sent back to their primary care provider for additional, less serious treatment, or to go through the referral process again, often with more detailed information or ancillary reasoning for the referral. Although referral management centres were initially tapped to help offset the costly burden of mistaken referrals sent to hospitals and specialists, the widespread use of these centres is proving to be more of a cost burden than a solution for the struggling healthcare system in the UK.
Referral Management Centre Costs
On average, referral management centres cost £10 per referral sent from a primary care provider, which on its face seems like a relatively small price to pay for the advanced evaluation. However, adding up the total costs of referral management centres over the last two years alone has revealed a £19 million expense handed down to clinical commissioning groups that use such a service. The British Medical Journal recently investigated the use and cost burden of these centres, requesting detailed information from all 211 clinical commissioning groups throughout the country. The results of the information request showed a disparity between the high cost of vetting referrals and the savings passed down to the healthcare system at large.
Out of the clinical commissioning groups that responded to the BMJ’s freedom of information requests, over half reported that a referral management centre was used consistently over the last two years. Private referral management centres – the costliest of the options for primary care providers – made up slightly more than one-third of service providers used, followed closely by in-house services and finally, NHS referral centres. Despite the widespread use of referral review services, only a handful of clinical commissioning groups could provide cost-related data to show the effectiveness of such centres. Just over 14% were able to highlight small cost savings through reducing the number of unnecessary referrals sent to specialists and hospitals, while an additional 12% were unable to prove cost savings on any level. In response to the report, some clinical commissioning groups reported that the purpose of the referral management centres was merely to improve the quality of referrals, not to reduce expenses.
Issues for Patients
One of the reasons why referral management centres may not be as efficient in cutting costs for clinical commissioning groups as they otherwise could be rooted in the structure of referral evaluation. Eddie Chaloner, a vascular surgeon at a leading vein clinic in the UK, explains the disconnect between clinical commissioning groups and referral management centres in detail, stating, “Recently, there has been further controversy when it became apparent that primary care provider practices were being paid by commissioning groups to reduce the number of patients referred to the hospital. The ethics of this practice are still a matter for debate. That may be due to the concerns expressed that delays or mistakes made by non-medically qualified people interfering with communications between doctors might be damaging patient outcomes.”
Referral management centre staff often follow a rigid guideline for which patient referrals should be approved and which should be denied. Should the staff be unfamiliar with medical issues common to patients in need of additional or specialty care, the prevalence of wrongfully declined referrals has the potential to increase significantly. When patients’ referrals are turned away and care is necessary, they are forced to go back to their primary care provider for direction, adding to the total cost of care for the country’s healthcare system. Overall, the use of referral management centres show no sign of slowing down, but they are showing even fewer signs of having a positive impact on patient care throughout the UK.
Author: Jose Calvo