Public Release: 

No evidence that referral management centres can deliver

Referral management centres: Promising innovations or Trojan horses? BMJ Volume 332 pp 844-8


No evidence exists that referral management centres can improve the NHS referral process, warn experts in this week's BMJ.

Referral management centres have been developed to monitor, assess, and redirect referrals between primary and secondary care. They are being heralded as a means to achieve a more efficient referral process that can match demand to supply and improves quality.

Researchers at Cardiff University searched the scientific literature but found no evidence that these centres are effective. The British Medical Association has also raised concerns about safety and confidentiality. Nevertheless, centres are currently being developed across England and Wales.

This has important implications, say the authors. Many potential benefits can be foreseen, especially to generate accurate data about referral volume and quality.

However, if referral centres decide to take on the responsibility of making decisions about where and if patients are referred, doctors may worry that their clinical freedom is being eroded and patients may worry about the lack of choice. Other possible effects will be loss of communication between generalists and specialists and a decrease in the continuity of patient care.

Although they believe that "something needs to be done" they do not know whether referral management centres will increase or decrease risk, efficiency, or choice, and little research evidence exists to support predictions of improved performance, they conclude.

Patients are not commodities, says general practitioner, Iona Heath, in an accompanying commentary. Those proposing and creating such centres seem to view a referral as a simple administrative transaction, whereas those working in primary care know that a successful referral is a much more complex and challenging phenomenon. She warns that these centres "run the risk of undermining not only the safety of patient care but also the complementary nature of the generalist and specialist roles and their consequent cost effectiveness."

Over-managing the referral process introduces errors and inefficiencies, adds Professor James Owen Drife. "Those who should object are the patients, who will not receive high quality care if they are assessed as units of disease rather than treated as people, he concludes."


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