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DEC 12/2014

What can GPs do to avoid unnecessary referrals and appointments?

For staff in GP jobs, time is a precious commodity. On a day-to-day basis, general practitioners will need to juggle a number of different roles and responsibilities, ranging from organisational and managerial tasks to their core functions of providing care for patients.

As such, it is important for doctors to constantly look into ways of reducing or eliminating any potential drains on their time and resources - which is why a recent study highlighting an emerging problem with unnecessary appointments and referrals may be of interest.

Naturally, medical professionals will always go the extra mile to provide patients with the services and care they require, but in instances where better outcomes could be achieved by avoiding unneeded consultations and admissions, it may be worth assessing alternative solutions.

The prevalence of avoidable GP consultations
The frequency of this issue was recently highlighted via an audit carried out by GPs Dr Komal Raj and Dr Callum McLean of the NHS Southern Derbyshire Clinical Commissioning Group, which examined all GP referral letters sent by the area's 20 practices during November 2013.

According to results published by Pulse, as many as one-quarter of these referrals could have been avoided through a combination of better signposting, education, pathway redesign and use of technologies.

Of all the letters assessed, 15 per cent of the referrals could have been dealt with by primary care, while another eight per cent were made before the condition had been fully explored. A further seven per cent were identified as re-referrals, with patients having to be referred for a second time after being wrongly discharged back to the GP.

Dr Raj said: "I think it's just busy practices … [that] have not looked at different ways to see patients or run their practices, and the end result is you get more referrals and admissions."

Moreover, the issue is likely to become increasingly pronounced in the coming winter months, with large numbers of patients visiting their local GPs to seek advice on minor or common ailments - a trend that is estimated to cost the NHS £343 million that could be better spent elsewhere.

Potential solutions
As Dr Raj indicates, many of these problems can potentially be remedied by embracing new technologies or methods of working.

For example, a recent study published in the London Journal of Primary Care suggested that thousands of appointments and phone calls could be avoided every year by allowing patients to access to their own records electronically.

The team extrapolated data from an assessment of 229 patients at GP practices in Glossop, Derbyshire and in Hyde, Greater Manchester, who were surveyed to work out whether accessing their electronic records had increased or decreased their use of the practice over the previous year.

It was shown that the 135 Hyde patients had made 255 fewer phone calls overall and needed 212 fewer appointments, while in Glossop the figures for 94 patients were 325 fewer phone calls and a reduction of 110 appointments.

The government has also recognised that new technology could be used to solve this conundrum, promoting the use of telehealth solutions and Skype consultations as a means of freeing up time for doctors, while offering greater convenience for patients.

A more controversial approach to this matter was discussed earlier this year when it was suggested that GPs could begin charging for appointments, but this idea was quickly rejected by the industry as potentially damaging to patient trust. As such, innovative thinking is likely to remain the main weapon against NHS inefficiencies.

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