xtra-contractual referrals (ECRs) c

xtra-contractual referrals (ECRs) can be a cause of considerable anxiety to purchasing authorities, mainlybecause of their potential to generate unexpected expenditure. But ECRs can also be used as a tool formonitoring the demand for, and quality of, clinical services. ECRs were studied in the Darlington HealthAuthority district using a variety of methods including inter-disciplinary meetings, a series of interviews withlocal GPs, and a questionnaire to general practitioners on 230 consecutive ECRs. The methods and results ofthe questionnaire study are presented. The commonest reasons for making ECRs included the mistaken beliefthat a contract existed with the ECR provider, patient dissatisfaction with the local provider, and referral tobenefit from shorter waiting lists. ECRs for bone-mass densitometry, orthopaedics, and ear nose and throatservices were over-represented. Questionnaire results were validated by comparison with an interview study ofall GPs in the district. We conclude that trends in ECRs can be monitored as a convenient 'early warningsystem' to alert purchasing authorities to changes in demand or perceived problems with local provider units.ECR data must be interpreted in the context of further local background information from sources such asGPs and public health physicians. In the case of Darlington, scrutiny of ECRs has led to changes in servicesand contracts. Key words: extra-contractual referrals, audit, purchasing health services.

xtra-contractual referrals (ECRs) can be a cause of considerable anxiety to purchasing authorities, mainly
because of their potential to generate unexpected expenditure. But ECRs can also be used as a tool for
monitoring the demand for, and quality of, clinical services. ECRs were studied in the Darlington Health
Authority district using a variety of methods including inter-disciplinary meetings, a series of interviews with
local GPs, and a questionnaire to general practitioners on 230 consecutive ECRs. The methods and results of
the questionnaire study are presented. The commonest reasons for making ECRs included the mistaken belief
that a contract existed with the ECR provider, patient dissatisfaction with the local provider, and referral to
benefit from shorter waiting lists. ECRs for bone-mass densitometry, orthopaedics, and ear nose and throat
services were over-represented. Questionnaire results were validated by comparison with an interview study of
all GPs in the district. We conclude that trends in ECRs can be monitored as a convenient 'early warning
system' to alert purchasing authorities to changes in demand or perceived problems with local provider units.
ECR data must be interpreted in the context of further local background information from sources such as
GPs and public health physicians. In the case of Darlington, scrutiny of ECRs has led to changes in services
and contracts.
Key words: extra-contractual referrals, audit, purchasing health services.

Xtra-contractual referrals (ECRs) can be a cause of considerable anxiety to, purchasing authorities mainly
because of their. Potential to generate unexpected expenditure. But ECRs can also be used as a tool for
monitoring the demand for and quality,, Of clinical, services. ECRs were studied in the Darlington Health
Authority district using a variety of methods including. Inter-disciplinary, meetingsA series of interviews with
local GPs and a, questionnaire to general practitioners on 230 consecutive ECRs. The methods. And results of
the questionnaire study are presented. The commonest reasons for making ECRs included the mistaken belief
that. A contract existed with the ECR provider patient dissatisfaction, with the, local provider and referral to
benefit from. Shorter waiting lists.ECRs for, bone-mass densitometry orthopaedics and ear, nose and throat
services were over-represented. Questionnaire results. Were validated by comparison with an interview study of
all GPs in the district. We conclude that trends in ECRs can be. Monitored as a convenient 'early warning
system' to alert purchasing authorities to changes in demand or perceived problems. With local provider units.
.ECR data must be interpreted in the context of further local background information from sources such as
GPs and public. Health physicians. In the case of Darlington scrutiny of, ECRs has led to changes in services
and contracts.
Key words:? Extra-contractual referrals audit purchasing,, health services.

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