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Referral pro-formas and pre-referral management

The LMC is aware for the increasing demand from providers both for GPs to complete what are typically over-long and bureaucratic referral forms and also to insist on GPs having followed a particular prescribed clinical pathway for their patients as pre-conditions of accepting referrals. GP’s professional and contractual obligations are limited to providing services meeting their patients reasonable needs delivered in the manner determined by the practice and to refer when they believe it is clinically appropriate, sharing whatever information they feel is required and is their responsibility to provide.

Whilst it is accepted that in some cases referral proformas may be helpful to GPs, on many occasions they are not and the information they require or the pre-referral management they insist upon may be over and above that which is clinically necessary. It is clear that frequently what is demanded from referring GPs is solely to meet the administrative needs of the provider rather than the clinical needs of patients.

In these circumstances GPs might find it helpful to append the text below, or similar, to their standard referral letters: This letter of referral is a clinical request for a specialist assessment, opinion or ongoing care. In some circumstances an attached referral proforma may not have been completed or has been only partially completed either because the information is not available at the time of referral, it is already contained in this referral letter, will follow or is not deemed clinically necessary or appropriate prior to referral. GPs are neither professionally nor contractually required to use referral proformas nor to follow any externally prescribed management pathway prior to referral, although of course they will always have due regard to any relevant authoritative clinical guidelines. Please do not reject this referral on the grounds of an incomplete proforma for reasons as described above as this may cause unnecessary delay and potential harm to patients. Furthermore any referral rejected for administrative reasons may result in responsible medical staff in your organisation being put in breach of General Medical Council guidance on good medical practice.

As ever, any GPs having concerns over the quality of care or services for their patients from secondary or community providers must bring these to the attention of their CCG.


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