NICE 2001/ 023
Issued: 17 July 2001
Press release
Update on the Referral Practice Project
The Department of Health and the National Assembly for Wales asked the Institute to develop a guide providing advice on appropriate referral from general to specialist services. A draft document 'Referral Practice' was produced in May 2000 and piloted within primary care. The pilots are now complete and the Referral Practice Project Steering Committee recently met to assess the results of the pilots.
In summary the Project Steering Group advised the Institute that the advice contained within the Referral Practice booklet provides 'best practice' in an area where little empirical research exists. This best practice should be disseminated to the NHS as part of a referral resource pack, with the aim of:
- stimulating local discussions between primary and secondary care practitioners on appropriate referral practice,
- providing a basis for setting standards and audit practice at a local level,
- ensuring that all local doctors including non-principals and locums have access to the same information to inform their work.
The Institute has accepted this advice and proposes to implement the decision in the following way:
(i) The original project group will be reconvened in order to review the current document in the light of the evaluation reports and update it as appropriate.
(ii) The document will be discussed with an educationalist to develop an appropriate approach for a referral resource pack
(iii) The referral resource pack will be disseminated by NICE and the Primary Care Collaborating Centre in the Autumn to coincide with the Modernisation Agency's new initiative on referral using facilitators.
For background information on this project please visit the Institute's website at www.nice.org.uk
Ends
Note for Editors:
| 1. | The Institute commissioned the development of a guide providing advice on appropriate referral from general to specialist services. Referral advice are consensus statements, (based on best available evidence) to aid clinicians in prioritising patients' needs for specialist services. The advice within the guide covers the following topics: | ||
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| 2. | The Referral Practice Guide and details of the pilots have previously been published on the Institute's web site (www.nice.org.uk) Pilots were led by the National Patient Access Team and a consortium consisting of City University and the Department of General Practice & Primary Care of St Bartholomews & The London, Queen Mary's School of Medicine & Dentistry. | ||
| 3. | The Referral Practice steering Committee met to consider the results of the pilots on the 24 May 2001. The minutes are published below. | ||
| 4. | Minutes of the Referral Practice Steering Committee held on the 24th May 2001 | ||
| In attendance: | Apologies | ||
| Professor Peter Littlejohns (acting chairman) | David Edwards | ||
| Professor Mike Pringle | Dr John Chisolm | ||
| Professor Robert Shaw | Oriana Dwight | ||
| Liz Bratton | Professor Sir George Alberti | ||
| Anne-Toni Rodgers | Sir Barry Jackson | ||
| Professor Joe Collier | Dr Marcia Kelson | ||
| Mary McClarey | |||
| Fred George | |||
| Andrew Dillon | |||
| Sir Michael Rawlins | |||
| 1. | PL as acting chairman explained to the steering group that despite the low turnout, following discussion with the chairman (ML), it had been decided to proceed with the meeting. The intention of the meeting was to formulate guidance to the Institute on how to manage the referral practice booklet in the light of the results of the evaluations. The preliminary deliberations would be circulated to all members of the group for endorsement before submitting it to the Institute. | ||
| 2. | PL described the pilots and their evaluation | ||
| 3. | It was disappointing that there was a low response rate to the national study (33%) and the National Patient Access Team's survey (46%). Some of this might have reflected a lack of clarity over the nature and status of the document but it also represented the view that primary care was under considerable pressure at the moment. This was considered to be due to a number of factors including managerial moves towards trust status. The document may have also been considered as another example of a central initiative which unlike others e.g. National Service Frameworks was optional. It should be noted that unsolicited research surveys in general practice rarely get above 50% so although the results should be treated with caution they could provide some information. NPAT subcontracted the second phase of their evaluation to another research group and did not undertake the 3rd phase. There was very little information on the methodology used in the NPAT project, particularly the number and representativeness of the general practitioners participating in the focus groups and interviews. In summary | ||
| 3.1 | The finding of the studies suggested that GPs considered that the subjects chosen for the referral guides were about right, their presentation was clear. | ||
| 3.2 | GPs felt that they would be more useful as part of a broader guideline | ||
| 3.3 | However as they currently stand they would be unlikely to change practice as they represented what GPs considered they were doing anyway (best practice). | ||
| 3.4 | It is interesting to note that the consultants interviewed were more supportive of the level of advice and felt that they may lead to more appropriate referrals. | ||
| 3.5 | There was a suggestion that their greatest impact would be as an educational resource. | ||
| 3.6 | There was also a general view that effective referral was likely to be as a result of initiating agreements with local consultants. This would take into account the level and type of resources that were available locally. It was thought to be difficult to address all these issues within a nationally developed guideline | ||
| 3.7 | However while local protocols may be "owned" by GPs basing them solely on uni-professional discussions with no reference to an evidence base may not reassure patients. | ||
| 3.8 | The steering group also discussed the draft copy of the " Guidelines for the management of medical emergencies in primary care" which is being developed under the aegis of the National Patient Access Team. In essence they are referral criteria with additional advice on disease management. Like the referral advice they start with the diagnosis being made rather than assisting in making the diagnosis. | ||
| 4. | Following a discussion of the perceived strengths and weaknesses of the referral in practice document it was concluded that the best way forward for the Institute would be for the Referral Advice to be disseminated with the aim of providing what was considered "best practice" in a field with very little empirical research. Its aim would be to stimulate local discussions between primary and secondary care practitioners on appropriate referral practice. As there appears to be consensus around the clinical content of the referral guidance it would provide a basis to set standards for clinical audit. It would ensure that all local doctors including non-principals and locums had access to the same information. | ||
| The proposal to incorporate the "emergency guidelines" while initially appearing an attractive option did not attract wide spread support form the rest of the steering group. It will therefore be commissioned separately. | |||
| To move the steering groups advice forward it is proposed that the Institute arranges for: | |||
| 4.1. | The referral document to be reviewed in the light of the evaluation reports and updated as appropriate. | ||
| 4.2. | The document should be discussed with an educationalist to identify what the resource pack should consist of. This might include audit advice which could be provided by the Primary Care Collaborating Centre. | ||
| 4.3. | Launched and disseminated as a referral resource pack by the Primary Care Collaborating Centre. | ||
