One of the regular tasks of a GP is to refer patients to secondary care and allied healthcare teams. Good quality referrals allow appropriate triage and are essential to smooth functioning of the speciality service. Ambiguous referrals on the other hand can often put the patients at risk, as well as burdening the service. In the following article, Dr Kunal Chawathey discusses the rationale behind referrals and provides useful tips to write high-quality referral letters. An important role of the GP is one of problem recognition and decision-making. Having said that, even the most broadly experienced clinician would struggle to single-handedly manage the vast variety of pathology encountered by GPs. A key aspect in the training of generalists is effective risk management, stratifying patients based on the significance of their signs and symptoms and referring them appropriately. Why do GPs refer? About one in 20 GP consultations result in referral to another sendee, making referral an important driver of cost to the NHS. Understandably, referrals are under constant scrutiny - a clinical commissioning group (CCG) recently classified GP referrals as appropriate, inappropriate, too early or 'bonkers' in their commissioning audit! Referrals are made for various reasons: To establish a diagnosis, for investigations not available in primary care, for treatment or an operation, for advice on further management and occasionally for reassurance. Patients may view their GP as an obstinate gate keeper to secondary care and sometimes demand to be seen by a specialist for trivial symptoms - increasing the number classified as 'inappropriate' or 'bonkers' in any commissioning audit!
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