Spiralling healthcare costs and demand, against a backdrop of financial austerity makes healthcare commissioning in England a real challenge. ‘Financial balance’ is a major priority, but, as reinforced by the Mid-Staffordshire NHS Foundation Trust failures, cost-cutting must not compromise patient safety and experience. Consequently, commissioners have looked to ‘demand management’ as a solution. This refers to methods used to monitor, direct, or regulate patient referrals from primary care to specialist, non-emergency care in hospital. In the UK, GPs act as gatekeepers and define which patients require referral to specialist care. As demand outstrips resources, the volume and appropriateness of these referrals becomes a major concern and much focus has been placed on managing rising demand. Indeed, in 2009, 91% of primary care trusts in England engaged in some form of referral diversion.1 However, the evidential basis for such interventions are lacking. Various strategies already tried have targeted primary care, specialist services, or infrastructure.2 These included encouraging ‘internal referrals’ within and between general practices, and task shifting clinical work from clinicians to nurses and other health professionals. Telephone triage systems have been used including large scale initiatives such as NHS Direct. Community-based specialist services, for example, heart failure nurses, chronic obstructive pulmonary disease (COPD) teams, and dementia teams, and ‘community matrons’ tasked with managing patients with long-term conditions, have been tried with varying success.3 Efforts were also made to empower patients to self-care such as the Expert …
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Jun 1, 2014
S Saksena + 3
Open Access
