Referrals

Scottish Medical Appraisal & Revalidation Toolkit Role specific additional considerations Sessional GPs Supporting Information

As a sessional doctor you will usually be able to review the quality of your referral letters, and the templates for review of content and efficiency of letters will be of some help. The increasing use of electronic referral may reduce the value of reviewing some aspects of the contents template.

You may find it more difficult to review the effectiveness of your referrals. You will need to get access to the patient records possibly three months or more after the referral has taken place - it is worth discussing this with the employing practice at the time to make sure this will be possible.

Also consider:

Referral letters (1): review of ten referrals - referral rate, reasons for referral, potential alternatives
Referral letters (2): review of the outcome from five referrals

GPs refer on average around 10% of their consultations to another agency.

They 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. There is some evidence that the average rate for sessional GPs is higher, although in many cases there may be appropriate reasons for this.

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

Referral tool for Sessional GPs

A tool has been provided for you, with the aim of helping you examine aspects of your own referrals and to reflect on your performance.

There are two parts to this tool depending on whether you are reviewing your referrals over the course of 10 surgeries (complete part 1 only) or 5 surgeries (complete both parts 1 and 2); after you have collected the data you are invited to reflection on what lessons have been learned from reviewing your referrals.

It may be helpful to discuss your planned referrals audit with the practice manager to facilitate follow up at a later stage and to ensure that the practice is aware that you will respect patient confidentiality.

You will need to review your referrals against a set of questions. The proforma allows you to tabulate your answers.

Referral tool for Sessional GPs

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