A PPF expert writes:

Let me give you two alternative models of open referral, either one being immensely preferable to that being operated by the major PMI’s.

The first is a hospital who acts as the recipient of an open referral. Under this model, the hospital would have agreed with its admitting consultants (aided by outcome data it had collected over the years) which ones would receive particular elective cases. This could be more than one consultant and in that case, the hospital could book the one with the shorter wait or the consultants could decide between them based on clinical factors for that particular patient.

This is still an open referral (the GP would be referring to the hospital with no named consultant) but crucially the PMI would not control the clinical process of which consultant would take the case.

Benefits to the PMI would (could) be lower cost when selection was based on the hospitals knowledge of which consultants had (for example) the shortest length of stay,  the least post op infections or readmission rates. Benefits to the hospital is that they participate in open referrals from that PMI and cement good clinical relationships with consultants.  Benefits to consultants are the retention of best and most appropriate clinical referrals and maybe a greater share of open referral volumes. The benefit to the consumer/patient is the potential for lower premiums (if the PMI passes on savings) and the knowledge that they are being treated in the most appropriate way as determined by their hospital and consultant.

The second model is just a variation on the same theme. It involves open referral to a consortium or chamber of specialists (e.g. musculoskeletal) who determine which of their group is the most clinically appropriate to take the patient. The hospital used will be the one chosen by the admitting consultant (with whom I would assume the consortium/chamber would have reached agreed charges). In this scenario, it is ALL consultant driven and the benefits are largely the same as described above.

I have still described an open referral scenario but in either case (and especially in the latter), it represents in my view a very acceptable process.

Hence why I said that I thought we should be careful about condemning “open referral” as a concept rather than the practice being adopted by major PMI’s.

I know the whole patient referral process in an emotive one but I think we can and should demonstrate that we are open to strong clinically sound alternatives to the ‘GP knows best’ route.

We all know that sometimes they don’t!

Print Friendly

Leave a Reply

discussion forum

Have your say on private healthcare in our discussion forum.

Visit the forum

archives by category

archives by month