To Whom Do GPs Refer? A Study of the Development and Change of Referral Networks of General Practitioners in The Netherlands

Abstract

One of the major goals of the recent NHS reforms has been to make the NHS more responsive to the needs of patients by offering more choice. DHAs and budget‐holding GP practices have been given an incentive to obtain better value for money in purchasing health care services. In doing so they will have to take account of the existing GP referral patterns for as “key advisers” GPs can have major influence on patients′ choice of hospitals and consultants. Until now not much has been known about the structure, development and change of referral patterns and the factors responsible for changes. A study concerning these issues, conducted in The Netherlands, provides relevant information for the British situation. The results (non‐specificity of referrals, the role of tradition and distance in building up referred relationships and patients′ influence on breaking up relationships) suggest that GPs′ decisions in building up and changing referral networks take place implicitly. Concludes that GPs need more information in order to choose the best option. Information exchange within GP practices or local/regional GP groups is a means of improving the basis for decision making. At the same time there is a growing need for research into cost/quality ratios of care offered by health care providers. In Britain, DHAs could play an important role in initiating and intensifying this research.

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“…However, this is only partly the case. Several studies have shown that GPs' preferences are also influenced by their (personal) relationships with consultants [23,24]. Therefore, mutatis mutandis, one could state that for GPs, as for consumers, not only technical aspects count, but also functional aspects.…”