Private firms run a third of CCGs’ schemes to screen GP referrals

At least 24 clinical commissioning groups across England are paying private companies to screen referrals from GPs to specialist care, The BMJ has found.

The BMJ’s investigation found that two fifths of CCGs that responded to its requests for information use a referral management system of some kind,1 despite previous evidence casting doubt on the effectiveness of such systems.2

The analysis—the first to track the number of referral management schemes in operation since CCGs were established in 2013—comes after The BMJ recently reported details of North Durham CCG’s decision to pay the private company About Health to screen all GPs’ referrals to a range of clinical specialties in a bid to reduce “unnecessary” outpatient activity and save money.3 The CCG’s move sparked concern among local clinicians and the BMA, which warned that CCGs risked repeating the mistakes of their predecessor organisations by commissioning schemes of questionable effectiveness.

The BMJ sent freedom of information requests to all 211 CCGs in England, of which 184 responded. Its analysis identified a total of 93 referral management schemes in operation in 72 CCGs, with some groups operating more than one scheme. Almost a third of the 93 schemes (30 schemes) are being run by private companies, with others run in house, by local NHS providers, or by the voluntary sector.

Only a seventh of CCGs that commissioned a referral management scheme were able to provide figures to The BMJ to show that their scheme had saved more money than it cost to operate.

The BMA said that it was concerned that financially challenged commissioning groups were rushing ahead to implement policies without a proper assessment of their effectiveness. Richard Vautrey, deputy chair of the BMA’s General Practitioners Committee, said, “They are leaping at these schemes without any clear evidence of benefit, and they’re just hopeful that it might reduce their costs. It is a very, very short term approach to healthcare management.

“We need to see much more evaluation . . . and not just keep making the same mistakes year after year.”

Vautrey said that some referral management schemes that enabled local specialists to provide rapid advice and guidance to GPs could be “very helpful” but added that many schemes obstructed GPs’ efforts to forge constructive relationships with consultants.

Graham Jackson, co-chair of NHS Clinical Commissioners, the membership organisation that represents CCGs, said that referral management was just one mechanism used by local groups to try to manage demand for services. “In many cases they provide a useful and effective role which is more than a redirection service,” he said.

Jackson added, “CCGs will balance the cost of commissioning with the benefit they provide to GPs and patients in terms of peer review, education, caseload management, and choice.”