AVOIDABLE REFERRALS - ANALYSIS OF 170 CONSECUTIVE REFERRALS TO SECONDARY CARE

Objective-To determine appropriateness of referrals from primary care to secondary care. Design-Retrospective evaluation of appropriateness of referrals from a singlehanded general practice: evaluations carried out independently by referring doctor and by second general practitio ner who worked in same area and had access to similar secondary care s ervices. Subjects-168 referrals made between 1 October 1990 and 31 Mar ch 1991 and followed up for up to 12 months by matching with available information on outcome of episode of care. Main outcome measures-Appr opriateness of referral and reasons for inappropriate referrals. Resul ts-110 referrals were agreed to be appropriate and 58 were considered avoidable. The reason for 32 of the inappropriate referrals was lack o f resources: 10 were due to lack of information (mainly failure of hos pitals to pass on information to general practitioner), nine were due to a deficient primary health care team; five were due to insufficient use of home care nurses, three were due to absence of direct access t o day hospital, and five were due to lack of access to general practit ioner beds or other facilities. Most of the remaining 26 avoidable ref errals were because available resources had not been fully used, becau se recognised management plans had not been followed, or because of la ck of skills to perform certain procedures. Conclusions-Many theoretic ally avoidable referrals were due to managers' and politicians' decisi ons about allocation of resources, but same inappropriate referrals co uld be avoided by assessment of general practitioners' needs for furth er knowledge and skills.