Table 2 Approaches to achieving and sustaining buy-in to referral management centres from referring GPs

Lack of awareness among referring GPs of the aims and purpose of the scheme

• Engaging GPs in dialogue during the development of the scheme

• Practice outreach through roadshows/practice visits

• Opportunity to be involved as a triager

• Regular newsletters/educational sessions on common referral issues

Cynicism and mistrust among GPs with respect to the achievements of the scheme

• Piloting systems and presenting evidence of success

• Performance management of RMCs to ensure quality of patient care is not affected

Resistance to changing referral behaviour

• Offering incentives for referring through the RMC

• Presenting bespoke data to practices at level of individual GPs to enable benchmarking

Frustration with bureaucracy

• Ensuring parsimony in administrative processes, e.g. evolving to include all specialties

• Ensuring GPs are kept up to date with changes to processes through regular communication/newsletters etc.

Challenge to clinical autonomy

• Moving from purely administrative to clinical triage (based on the assumption that feedback from a fellow clinician would be better received than that from ‘some manager or clerical person’ [Int. B4])

• Taking the approach of changing referral behaviour through education alone (with GPs retaining ultimate responsibility for referral destination)

• Providing feedback to GPs on their referrals that supports education and learning

• Ensuring that the tone of this feedback is moderate and advisory