The meaning of information on GP referral rates to hospitals

Research shows consistently wide variations in all aspects of general medical practice. Extreme variations in rates of referral to hospital have recently been highlighted, but remain largely unexplained. New information systems now make it possible to identify GPs with very high or very low rates of referral so that their behaviour can be reviewed. Before using this information politicians, managers and doctors should give careful thought to what it means and its limitations. The rate of referral provides no indication of the appropriateness of referrals. Any intervention designed to improve the referral mechanism should aim to increase the proportion of people who are appropriately referred to hospital and to reduce the proportion who are inappropriately referred. This is unlikely to be achieved by focusing attention on GPs with high or low rates regardless of how they are made up.