Before you refer, think whether a referral is really necessary.


In terms of referrals, patients fall into three categories:

  1. White cases - those that definately don't need referral. For example, a patient who has started with a new sore throat for less than three days who has nothing but a bit of redness of his pharynx.
  2. Black cases - those that definately need referal. For example, the patient who is complaining of new altered bowel habit or abdominal pain with deep dyspareunia.
  3. Grey cases - those that you're not sure about. You can probably think of a whole load of examples for yourself.

Think about your options

It's not the black or white cases that cause us angst. It's the grey cases. There are several things you can do to make these grey cases less grey and more black or white:
  • Do more tests - for example, you can get your District Nursing team to to Doppler APBIs for someone in whom you suspect peripheral vascular disease rather than referring to the vascular surgeons straight away.
  • Get the advice of another doctor - for example, a GP with a special interest in the clinical area in which you're having difficulty. This might be a doctor within your own practice and you could ask the patient to see them.
  • Phone for advice - ring the on call specialty based doctor and ask for their advice - could save an unnecessary referral and you'll be wiser at the end of it too!
  • Refer to someone else in your PHC team - can the midwife or health visitor help your resolve. Rather than referring to a dietician at the hospital, perhaps your own practice nursing team are skills enough.
  • If you have to refer, see if there is a community GPSI clinic and preferentially refer to that (often the referral costs are cheaper than in primary care and the service a lot quicker).
  • 'Choose and Book' will often tell you what other services are available in your area which might be more appropriate than the service you originally thought of.

All I am say is think before you refer. I am not say don't refer - just think! Remember, patients who are unnecessarily referred will then undergo an array of tests which will cause them immense anxiety even if everything turns out alright in the end. One of the things in the Hippocratic Oath is not to cause unnecessary harm.

And don't forget about the PACE guidelines

In Bradford, a working group constantly develops guidelines in light of NICE recommendations. These quick, simple, easy to follow guidelines and are available for viewing here.Refer to them - they will help you decide when a referral is necessary.