Why a referral is refused

GENERAL PRACTITIONERS make over nine million referrals to hospitals a year, leading to an expenditure of approximately £15 billion. In times of cutbacks, GPs will be looking at managing those referrals in an effort to improve care and save money.

Referrals to hospitals are often needed if the patient is to receive the optimum treatment for their condition.

However, not every referral from a GP results in vital treatment being given — a lot of them are frankly unnecessary.

Some patients are referred for conditions which can be treated perfectly well by a GP in primary care (eg mild acne), and do not need specialist input.

GPs are often under pressure to “do something” which may be to make a referral, even if a specialist appointment will not actually alter the management of the condition. Also, many referrals are made for reassurance and a specialist opinion rather than treatment — and seeking that comforting second opinion is costly.

In the future, it will not always be guaranteed that you will get the referral you request. You may want to see a specialist, you may even feel you need to see a specialist, but unless the GP feels it will actually improve the management of your condition, he will not send to one.

There are now lists of treatments that are not offered on the NHS because they are deemed expensive and unnecessary, ranging from varicose vein surgery to removal of benign moles.

Perhaps most surprisingly, even if your GP does sanction a visit to a specialist, it may be rejected by a management team who are tasked with scrutinising the reasons for every referral. This means that rather than being offered a letter for an appointment, you will receive a letter saying your appointment has been rejected.

The referral management teams, thankfully, are doctors, and all the criteria for referrals have been set by clinicians. The idea is that referrals are made correctly to the right specialist and only if it is beneficial to the patient.