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GP-UK  October 2010

GP-UK October 2010

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Subject:

Re: Analysis of referrals

From:

Saul Galloway <[log in to unmask]>

Reply-To:

GP-UK <[log in to unmask]>

Date:

Mon, 11 Oct 2010 13:02:12 +0100

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (97 lines)

I think you are stretching too hard for a line there. Based on that
data there may simply be no correlation (or at the very least too many
confounding factors to make it meaningful).

The single biggest (proven) factor in patient cost/annum is age
(despite the current funding formula over weighting deprivation). Try
plotting your pop > 70 (or some other cuttoff you can get to say over
65 for Korner bands)  per practice against total average spend per
patient (including all budget areas not just OP) and see how that
looks.

If you are looking at new referral spend only, then elimination of
unnecessary referrals (or at least a reduction in total new referral
count) *will* cause first appointment costs to fall. However, under
PBR there is no way of turning down (or off) the tap of 2' care
capacity, so I suspect that the trust simply fills slow and
potentially complex "firsts" with more than double the number of FU
appts.

Interestingly the The EuropeanStudy of Referrals from Primary to
Secondary Care showed a counter-intuitive relationship between
referral rate and number of GP consultations a day, in that the busier
the GPs the less they referred. Their idea was that practices that
were very active in seeing their patients may be undertaking a wider
range of activity in primary care (this was in a european context).

When we did some referral analysis in Oxford years ago in fundholding
days I think the range of referral rates/consultation varied by a
factor of 2 from lowest to highest referrers. High referring could
represent either expertise or underconfidence/ignorance, practices
with very high average list sizes (say 3000+ per FTE including
assistants and registrars) were low referrers (possibly a choke effect
of not being able to get to see the GP?), training practices did not
refer more (though you might have expected them too) and as I recall
lots of people got very defensive and excitable about the subject
area. I'm not sure it got us far.

What I was after was a breakdown of % reasons for referral, e.g. what
% of ortho referrals are for should pain or knee replacement, etc

On 11 October 2010 08:52, Holmes Alistair (WEST SUSSEX PCT)
<[log in to unmask]> wrote:
> Will see if our group has similar properties
> Alistair
> ________________________________
> From: GP-UK [mailto:[log in to unmask]] On Behalf Of Roger Gardiner
> Sent: 11 October 2010 08:24
> To: [log in to unmask]
> Subject: Re: Analysis of referrals
>
> Sure
>
> First a quick explanation of why the graph is unexpected:
>
> If you eliminate unnecesarry referrals (e.g. by using a referral management
> centre) then they should form a lower proportion of the total spend - this
> is because referrals only affect certain elements in expenditure
> (prescribing, community, A/E etc. should not be affected) so the total spend
> does not fall in parallel.
>
> For example: a 50% drop in referrals may only lead to a 20% drop in overall
> costs. if referrals drop from £10 to £5 and the total spend drops from say
> £100 to £80 then New OP costs/total expenditure will drop from 10/100 or 10%
> to 5/80 or 6.25%. --- that's the theory.
>
> If you look at the graph you'll see the reverse ---- it fairly scattered but
> the trend is that an increasing % spent on new out-patients leads to a fall
> in total expenditure ----  it certainly doesn't show the reduction in
> spend/patient we've all been told.
>
>
> Roger
>
>
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