I’m not quite sure what I think of the King’s Fund: some of their papers seem to me to miss the point: academic distance from reality can be damaging.

They have examined Referral Management Centres and concluded that they aren’t very good, which was obvious to GPs but lost on politicians. Quite interesting.

What I find more interesting though is what their researchers have to say about GP referrals in general. There seems a belief that variation in referrals are bad and similarity is good. The question of why? doesn’t seem to enter (some GPs may have lots of experience in psychiatry, for example, and are able to handle a great deal of it: other areas may have an older, younger or student population; other practices may have access to an excellent secondary care service that other areas don’t.) And then there is the repeated non evidence based assertion that cancer and renal referrals are often ‘late’, which the evidence doesn’t back up and which I’m getting rather tired of.

But anyway. This report is good in the sense that it examines a non evidence based policy. But it is bad because it doesn’t recognise how complicated the factors that go into making a referral are, or even that there is always a right and wrong answer.

It’s easy to say that