Domain 2:

Safety and Quality

QIA: Referrals

GPs refer on average around 10% of their consultations to another agency.

They have been criticised by hospital colleagues for both over and under referral. There is no gold standard for the "right" number of referrals, but it is also clear that we can sometimes fail to refer or we can refer inappropriately through lack of knowledge or skills.

Sessional GPs have been criticised for having a higher referral rate. There is some evidence that the average rate for sessional GPs is higher, although in many cases there may be appropriate reasons for this.

Research has shown that the number of referrals made will depend on several factors:

  • The case mix of patients seen
  • The personal experience of the doctor - "expert" doctors may be able to handle more complex patients personally, but some actually refer more often in their own specialty
  • Lack of knowledge of the patient
  • Lack of home support or resources to care for the patient in the community
  • Uncertainty or lack of confidence of the referring doctor
  • Inability to offer follow up to monitor the situation
  • Failure to appreciate that secondary care may be able to offer additional help
  • Patient or carer anxiety

Referral tool for Sessional GPs

The aim of this package (download at bottom of page) is to allow you to examine aspects of your own referrals and to reflect on your performance.

There are 2 parts to this tool, either:

You are asked to keep a log of the referrals you make in the course of 10 surgeries.
You then complete Part 1.


You are asked to keep a log of each referral you make in the course of 5 surgeries.
You then complete Part 1 and Part 2.


You are invited to write a reflective statement on what lessons have been learned from reviewing your referrals.

It may be helpful to discuss your planned referrals audit with the practice manager to facilitate follow up at a later stage and to ensure that the practice is aware that you will respect patient confidentiality.

You will need to review your referrals against a set of questions. The proforma allows you to tabulate your answers.

Part 1

  1. What proportion of all your consultations resulted in referral?
  2. What conditions did you find which you felt required referral?
  3. When making the referral were you able to identify details of the past medical history, current medication and psychosocial data from the practice records?
  4. Did you feel it would have been possible to discuss your decision to refer with one the GP principals to explore alternatives to referral for any of these patients?
  5. Did you identify any areas in which it seemed to you that the existing management of the patient was sub-optimal?

Part 2 (an additional option which has learning value)

For this section it is suggested you contact the practice manager at a later date, and arrange a visit to review the medical records of your referrals to assess the outcome.

  1. Did the outcome match your expectations?
  2. Did you learn anything as a result of the referral?
  3. On reflection was the referral appropriate or would you now do anything differently?
  4. Did the referral follow the most effective pathway? (For example did it follow a local referral protocol, did the patient attend the most appropriate specialty, did you support your referral with appropriate initial investigations?)

Conclusion (both parts 1 and 2)

You are invited to write a reflective statement on what lessons have been learned from reviewing your referrals.

Referrals pack for Sessional GPs | File Size: 79 KB | Date Updated: 11/03/2014

This page was last updated on: 18/08/2016