Referral management schemes: good for whom?

Clinical commissioning groups (CCGs) in England are spending millions of pounds on schemes that sift through referrals from GPs to specialist services, some claiming that they reduce costs, while others hope to improve the quality of referrals. But an investigation by The BMJ has found that only a small fraction of schemes are being fully evaluated, leading to questions about their purpose and the effects they are having on patients and doctors.

The BMJ sent freedom of information requests to all 211 CCGs in England, asking for details of any referral management schemes they had in operation. Of the 184 CCGs that responded, 72 (39%) said that they currently commissioned some form of referral management scheme as part of efforts to manage outpatient activity in local hospitals.

A fifth of responding CCGs (36) have commissioned a new referral management scheme since CCGs formed in April 2013. The same number have continued to commission schemes that were previously set up by primary care trusts, the organisations that were superseded by CCGs.

Of the 93 schemes identified, 30 are run by private companies, 27 are run in-house by CCGs, 10 are operated by NHS commissioning support units, 10 are run by NHS trusts, nine are run by not-for-profit organisations, and seven are operated by local GPs or other clinicians.

Just under half (42) of the 93 schemes have been introduced by CCGs since 2013, with the remaining 51 carried over from previous schemes run by primary care trusts.