I think referral management as it's often done is often a transparent
attempt at cost reduction, which may or may not be appropriate.
The factor of two between referral rates of some doctors does bear
examining, and I would see this is the same way as prescribing data
analysis, you kind of have to do it in order to apply some sort of
evolutionary/herd/peer pressure to bear. It is similarly
multifactorial, and similarly high cost prescribing is not necessarily
bad.
There are several other reasons for analysing and tracking referrals,
which I would argue are far more useful than the simple benchmarking
of rates function (which has some utility).
1. As a kind of accrual view of costs yet to come (given that SUS data
and then flex and freeze might delay you by 6 months from referral to
bill).
2. As a way of working out what your highest volume and cost pathways
are, because those might be the ones you will target for early
attention.
3. Because we are going to need to control non-GP to 2' care activity
too, and understanding the type/volume/reasons for this is central.
4. Because we need to understand the relationship between private and
NHS referral % across practices in fair share budgets, and also in the
gross referral rate because this forms one risk (if there are shifts
in private cover use).
5. Because some activity is priced at comedy and unjustifiable levels
for what goes on, and those services might be ones that your
consortium would want to commission elsewhere or arrange to be
provided (possibly via a provider arm if local 2' care is
intransigent)
I don't think that OP activity management is an option if you are
responsible for the whole budget, though its not the most financially
loaded area (non-elective IP is).
DOI, our group has been trying for "at risk" budgets for some years,
but cannot do so whilst PBR is the only show in town.
On 11 October 2010 13:45, Julian Bradley <[log in to unmask]> wrote:
> At 13:02 11/10/2010, you wrote:
>>
>> 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).
>
> Isn't the onus on those who want referral management (beyond the system of
> having primary care and referrals to secondary care that is a major plus in
> the UK) to show that the extra cost is worth it?
>
> If there is no correlation, referral management is NOT value for money. If
> Roger's hypothesis is right it's even worse, but ONLY if there was a clear
> correlation about reduced first referrals reducing costs without harming
> health would it be legitimate.
>
> Julian
|