Independent evaluation of the North East Hampshire and Farnham Integrated Primary Care and Acute Care Systems (PACS) Vanguard Referral Management Scheme [RMS]: survey of GPs

1.Background Improving the informational quality of referrals and reducing referral rates by appropriately re-directing them is a key goal of clinical commissioning groups in England (Wright et al, 2015). 2.Aims Based on the key outcomes from the Logic Model, a referral management system in PACs Vanguard in Wessex reviewing 80-90 referrals per week was evaluated to investigate the views of the GPs and GP reviewers about the referral management scheme in order to identify potential areas for service development in the community and to ascertain which factors have enabled the successful engagement of GPs. 3.Methods A survey collecting both quantitative and qualitative data was sent to the GP practices at the end of October 2016 to be circulated to the GPs involved in the referral management scheme. A total of 17 GPs out of a potential 43 responded (41.8%). Although the number of respondents was 17, the number of responses per question ranged from 7 to 14. Only one GP reviewer out of the three responded. 4.Results More GPs had identified areas of learning as a result of feedback [38.4%] than of personal reflection [25%] Areas of learning identified were: new referral pathways in cardiology (atrial fibrillation and 24hr ECG), gynaecology and dermatology, yet 71.4% of GPs disagreed that the referral management system had greatly improved the way in which they made referrals while the GP reviewer agreed with the statement because GPs were aware of the cost effectiveness of the new referral pathways. Just over two thirds [69.2%] were satisfied with the way in which decisions of the referral management service were fed back to them, yet 48% of the free text comments were criticisms of the lack of quality of feedback and suggestions on how to improve feedback. 5.Conclusion (including limitations) The sample of GPs and GP reviewer was limited (39.5% and 33.3% respectively) The question as to which factors have enabled the successful engagement of GPs remains unanswered. The survey underlined shortcomings in the feedback to GPs. Suggestions for improvement either from GPs or the GP reviewer did not mention some key findings of strategies found effective highlighted in the literature such as guidelines with structured referral sheets which can be effective in changing referral behaviours (Abkari et al, 2008; Imison and Naylor, 2011). 6.Recommendations Individualised and more detailed feedback emailed by practice manager or by referral system directly/GP reviewer (with copy of original referral letter). A monthly summary about local clinics and other services to which to refer patients well as their waiting times and their referral criteria. Regular updates about the performance of the referral management scheme and the extent of reductions of inappropriate referrals/successful re-directions of referrals. Greater involvement of trained non GP staff undertaking the redirections, releasing GPs to return to patient care. A quicker turnaround of referrals, but this will require more GPs being prepared to be a part of the viewing team. This is more likely to happen if they are regularly kept up to date about the referral management scheme.