Increase in GP referrals reflects policy conflict

 GP referral rates have risen by almost 10% in the last year, despite falling by 2.1% between March and November 2011.

The Department of Health figures indicate that the earlier fall in referral rates was a consequence of PCT rationing, which Health Secretary Andrew Lansley declared “unacceptable” in September 2011.

However, the subsequent rise contradicts Lansley’s recent claim that CCGs are reducing referral rates through better case management.

There were 11.6 million GP referrals in the year to May 2012, approximately a million more than in the previous year.

Mike Dixon, Chair of NHS Alliance, commented: “The reduction of the year before was due to a focus by CCGs and PCTs on demand management, but service redesign is what’s needed to make that sustainable.”

Similarly, Humber PCT cluster Chief Executive Christopher Long said the initial fall in GP referrals was due to referral management schemes that were not sustainable, while the subsequent rise was due to growing patient demand.

These comments point to an underlying conflict in DH policy on referrals: the Government wants to see referral rates fall, but not for the ‘wrong’ reasons.

According to the Health Service Journal, active referral management and restrictions on procedures of ‘low clinical value’ were the major tactics employed by PCTs to bring down referral rates.

These tactics were criticised by Lansley and effectively banned by the NHS Operating Framework for 2012–13.