General practitioners' referral thresholds and choices of referral destination: An experimental study

General practitioners (GPs) exert a major impact on NHS resource use, both as providers of primary care and as referrers to secondary care. Referral r ates are subject to wide variations, leading to the conjecture that certain GPs may have different 'referral thresholds' from those of others. In this paper, the authors describe an experiment designed both to test the referr al threshold hypothesis and to illuminate the GP's decision process with re spect to choice over referral destination. Nottinghamshire GPs were provide d with hypothetical case histories and a list of possible referral destinat ions, specifying a range of consultants, their specialist interests, plus t he expected waiting times and costs for both out-patient investigation and in-patient treatment. For each case, respondents were requested to indicate whether or not they would refer the patient, and to whom. Respondents were also asked to indicate the extent to which their choices of consultants ge nerally were governed by the specialist interest, the waiting time and the cost information. The responses of the sample support the referral threshol d conjecture, with specialist interests and waiting time appearing to be fa r more important than cost in influencing choice of referral destination. T he possibilities of influencing GPs' referral behaviour are discussed, in t he light of recent initiatives with respect to prescribing. (C) 1998 John W iley & Sons, Ltd.