TY - JOUR T1 - What do we actually know about the referral process? JF - British Journal of General Practice JO - Br J Gen Pract SP - 752 LP - 753 DO - 10.3399/bjgp11X613278 VL - 61 IS - 593 AU - Peter Davies AU - Roger Pool AU - Graham Smelt Y1 - 2011/12/01 UR - http://bjgp.org/content/61/593/752.abstract N2 - As GPs we make referrals to consultants and allied health professionals every day. It is a necessary part of what we do. We know that we try to take patients from square one in primary care and pass them on to more specialised colleagues if they need to go further into the healthcare system. We try to do this well, and to make careful and well judged clinical decisions about whether we, or a more specialised colleague, will provide better care to a particular patient. We are proud of our gatekeeper function and our role in making sure that the right patients reach the right consultants. We are also proud of the converse which is our key role in guiding patients who do not need specialist care safely away from the cost and potential perils of specialised medical care. We can point to Barbara Starfield’s1 work that shows how effective primary care can be when done well, in terms of allowing specialists to work more effectively and in saving lives and reducing healthcare costs.We also know that secondary care is the expensive part of any healthcare system. Primary care is cheap, and deals well with 90% of cases presenting to the healthcare system.2 The alternative view of this fact is that secondary care deals with the most severe 10% of cases, who are the ones ill enough to actually need treatment.3The decisions GPs make about referral are crucial both for the patient’s progress through the system, and for their effect on the costs incurred by the system. Any clinical decision to refer a patient is unavoidably also a financial decision to spend NHS resources.4 NHS resources are finite and the demands on … ER -