GP referrals and demand management

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General practitioners make more than 9 million referrals each year. This page brings together some of the evidence around interventions and approaches around managing demand.

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Search hints: Useful MeSH terms:

  • exp REFERRAL AND CONSULTATION/sn [Statistics & Numerical Data]
  • exp FAMILY PRACTICE/sn [Statistics & Numerical Data]
  • Combine with the service of interest eg Community Health Services/sn [Statistics & Numerical Data]
  • Dont forget to add exp GREAT BRITAIN/


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Tools and Resources

Demand Management: Good Practice Guide (NHS England August 2016) – A list of initiatives and actions that CCGs should consider implementing locally, in collaboration with providers and other organisations, to effectively manage the increasing demand for elective care services (particularly to reduce unnecessary outpatient appointments). Supplemented by case studies.
Summary of actions and initiatives:

  • Peer Review of Referrals
  • Shared Decision Making
  • Choice
  • Advice and Guidance
  • Alternatives to Outpatient Appointments
  • Consultant-to Consultant Referral Protocols
  • Direct Access to Diagnostics
  • Management and Monitoring of Outpatient
  • Follow up Appointments

Resources, guidance and tools for capacity and demand management – Appendix D of Operational resilience and capacity planning for 2014/15 (June 2014)

Demand Management (NHS Institute National Archives page)
A quality and service improvement tool outlining approaches which can be used at various stages of the patient pathway. Includes a number of approaches, tools and websites

The Big Referral Wizard: A Guide to Systems Management in Healthcare (NATPACT)
The wizard is designed to provide you with all the information and tools that you will need to develop an understanding of the various different parts of the referral processes and the systems within which they operate.

Predicting service demand: a simple model
This guidance is based on the practical experiences of one social care shire authority offers a simple and unsophisticated model which comprises 22 separate steps towards predicting social care service demand and responding to this demand.

NICE ‘Referral Advice’ Recommendations Database (NICE)
Primary-to-secondary referral advice from NICE clinical guidelines, cancer service guidance and public health guidance.

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Sources of  data

Monthly Hospital Activity – data relating to elective and non-elective inpatient admissions (FFCEs) and outpatient referrals and attendances for first consultant outpatient appointments. Available by CCG and provider.

NHS Comparators (Registration required) – CLOSED 31 MARCH 2015
The Commissioner View includes useful benchmarking data including Outpatient Follow-up to First Attendance Ratio, total admissions per 1000 broken down by GP practice and specialty.

Hospital Activity data from NHS England – Quarterly activity data relating to GP and other referrals for an outpatient appointment, the total number of attendances at consultant outpatient clinics; including patients seen for their first appointments as well as those attending for subsequent or follow up appointments.  Also, the number of patients who did not attend their outpatient appointment (DNA).

GP Practice data in the NHS IC Indicator portal – data  for hospital activity including A&E attendances, admissions, outpatient appointments and follow up activity by General Practice.

GP “No Follow-up” Rate HSJ Performance Healthcheck
An online tool highlighting the potential savings to be gained by reducing the number of first outpatient attendances that do not have any follow-up appointments or admissions within a given timeframe. Also includes some data on follow up by speciality.

Out-patient referral rates per 1000 patient years at risk, by clinical specialty, age, sex and deprivation category: 1994-98
Analyses of data from the General Practice Research Database: prevalence of disease, GP out-patient referrals to secondary care, prescribing of drugs, management of disease.
IN: Time trends in GP outpatient referrals Health Statistics Quarterly 2001, no 10, pp 14-19

Trends in consultation rates in General Practice 1995-2009 HSCIC Sept 2009. The last in a series with cumulated data for calendar years 1995 to 2009. It includes analysis by age and sex, the number of consultations for the typical general practice, consultations by  health profession (eg GP or nurse)and on where the consultation took place.

The Centre for Health Economics (CHE) at York University  in their report NHS Productivity from 2004/5 to 2010/11  used data from the annual GP Patient Survey, (the percentage of patients answering “in the past 3 months” to the question “When did you last see a doctor at your GP surgery or health centre?”)  to estimate number of GP consultations and conclude that number of consultations in 2010/11 has fallen back to 2006/7 levels (See Table 7.7).

Key reports, policies and research

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Case studies and examples of Referral Management systems

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