OPEN REFERRAL ANALYSIS
Based on an article by DR Richard Jenkins, Staffordshire GP,
 Practical Commissioning, February 2007 p 35-37

GPs have been the traditional gatekeepers for referring patients to non-urgent NHS services that cannot be delivered in Primary Care. This accounts for 20% of PCT Budget and is therefore a target for resource savings.
PCT referral centres or CATs will not change referral patterns but triage them without engaging the GP who will just perpetuate their current referral habits. 
Change can only happen by analysing referrals and identifying whether they can be avoided by being dealt with in Primary Care. (Peer Analysis)
Could we treat or investigate the patient in-house? 
It is an excellent means of identifying learning needs.
It forms a good structure for an educational event- examining referrals together or inviting a Consultant to help out with these.

Method
The PCT’s referral data for Parkwood Drive Surgery and the Locality must be received and analysed on a quarterly basis. Where there is a discrepancy in the referral rates between the Practice and the Locality the referral data will be analysed in the Practice as described in the following business plan.

Step 1; Elect a responsible partner to oversee data collection, secretaries to be informed how and when to collect data (keep the batch of appropriate referral letters), and all GPs in the practice to sign up to an open discussion on their referrals. This must be a no-blame and just culture.

Step 2;  Select a speciality where savings could be made i.e. high volume of referrals and some in-house expertise or invite a Consultant (according to their availability). (Dr Jenkins analysed referrals for breast surgery, dermatology, urology and ENT). 
All referral letters to that speciality in that month were analysed by the project lead (2 hours or so- paid for by DES money). Why the referral was being made and what the GP wanted for the patient from the referral was identified. This was written on an Excel spreadsheet.

Step3; Study the spreadsheet and the letters at a Practice meeting. All letters should contain a reason for referral, expected outcome and GP’s differential diagnosis. The GPs can then compare letters with their peers. Suggested outcomes are then noted.

Step 4;  Act on outcomes. Are the letters appropriately structured, are there guidelines for referral for investigations, to Specialists or treatments. Note these and refer to them in a practice document.

Outcomes
Addresses learning needs and improves clinical confidence and skills.
Reduce referrals and associate costs with savings being used on other services.
Patient satisfaction in avoiding unnecessary investigations and referrals which delays their clinical improvement.
Richard Gallow
Senior Partner, Parkwood Drive Surgery