General practitioner referral rates.

Interpretation is difficult There are large differences in how often general practitioners refer patients to hospital.'14 These differences are attracting growing attention-partly from the Department of Health and Social Security, which is concerned to ensure the efficient use of resources, and partly from district health authorities, some of which have tried to save money by limiting referrals from general practice. The problems of four strategies for reducing referral rates are explained at p 461. There are, in addition, many problems in measuring general practitioners' rates of referral, and these problems need to be understood before the rates can be interpreted. Deficiencies in the data used to calculate these rates may lead to important errors. The first step in calculating a rate of referral is to count referrals. In much of the published work this has been done by general practitioners participating in a research project. If information on rates of referral is to be provided to general practitioners regularly, as suggested in a recent white paper,5 information on referrals will probably need to be collected from hospital computers-and systems designed to collect this information are being developed. These systems will need to include extensive cross linking of hospital computers as patients are often referred across health authority boundaries. At present most hospital patient administration systems do not relate referral to the referring general practitioner. According to local custom, the general practitioner associated with a patient on the computer may be the referring general practitioner, the "usual" general practitioner (the Korner definition), the registered general practitioner, or even the senior partner. Substantial changes in hospital computing practices will be required before valid data on referrals can be provided. Collection of information on referrals needs to take account of the different ways in which general practitioners refer their patients. Although overall less than 7% of referrals are made privately and only 2-5% of referrals are requests for domiciliary visits,6 in one study there were almost as many geriatric domiciliary visits as geriatric outpatient referrals7 and in another some general practitioners referred half their patients privately.3 The second step in calculating rates of referral is to divide referrals by either the number of patients registered with a doctor or the number of consultations over a period. Several studies have used an individual general practitioner's list size as the sole denominator,8-" an approach that may give rise to serious errors. If, for example, an …