Transfer of clinical responsibility and risk in advice and guidance referrals

One of the key roles of the general practitioner is to stratify risk and manage multiple undifferentiated, covarying, evolving illnesses. The key objective is not always to arrive at a definitive conclusion or diagnosis, but to act as a gateway to further management.Referral is a major part of both the GP’s role and the patient’s experience. Referrals are an important cost driver in the health architecture and are made for many reasons. The decision to refer is never taken lightly.Referral usually involves a transfer of clinical responsibility and risk. Although advice and guidance can work well in some circumstances, some who view it through the lens of pragmatism or cynicism say that it is being used as a mechanism to avoid seeing patients, to cut costs and waiting lists, and to bounce the risk and responsibility back to the referring GP.1Quite often the caveat in the consultant letter back to…
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