Domain 2:

Safety and Quality: Referrals

Referrals Review for OOH doctors

Overall, GPs refer on average around 10% of their consultations to another agency. In out of hours care the figure is usually higher, reflecting the case content of immediately necessary care.

We have been criticised by hospital colleagues for both over and under referral. There is no gold standard for the "right" number of referrals, but it is also clear that we can sometimes fail to refer or we can refer inappropriately through lack of knowledge or skills.

Sessional GPs have been criticised for having a higher referral rate than GP Principals. There is some evidence that the average rate for them is higher, although in many cases there may be appropriate reasons for this.

Out of hours services do not necessarily have appropriate information or resources to provide continuing management in the community and referral may be seen as a safety net. However, the extent to which this is used varies widely between OOH doctors.

Research has shown that the number of referrals made will depend on several factors:

  • The case mix of patients seen
  • The personal experience of the doctor - "expert" doctors may be able to handle more complex patients personally, but some actually refer more often in their own specialty
  • Lack of knowledge of the patient
  • Lack of home support or resources to care for the patient in the community
  • Uncertainty or lack of confidence of the referring doctor
  • Inability to offer follow up to monitor the situation
  • Failure to appreciate that secondary care may be able to offer additional help
  • Patient or carer anxiety

Referrals Proforma Tool for OOH GPs | File Size: 97.5 KB | Date Updated: 11/03/2014

This page was last updated on: 18/08/2016