title: Dealing with extracontractual referrals.
abstract: OBJECTIVE
  To describe the mechanism established by Richmond, Twickenham, and Roehampton Health Authority to manage extracontractual referral requests made on behalf of its resident population and to examine its working in the first three months of the new arrangements.
  
  
  METHODS
  Description of the procedures for managing extracontractual referrals and the decisions made on requests submitted to the district health authority between 1 April and 30 June 1991.
  
  
  RESULTS
  235 requests were submitted, 79 for emergency care. 156 requests were clearly for elective treatments and, of these, 61 were ultimately refused, 20 because the district health authority was not liable to pay. Of the remaining 41, 17 were appealed successfully and three unsuccessfullly. More than half of the elective extracontractual referrals correctly submitted were to either orthopaedics, general surgery, oral surgery, gynaecology, or plastic surgery. Overall, the district health authority approved three quarters of the requests for which it would be financially liable; this was the predicted workload for the period.
  
  
  CONCLUSIONS
  The management of extracontractual referral requests is complex and time consuming for clinicians and managers alike. Patient choice is clearly being limited to some extent, but this is necessary if the number of requests is not to exceed the levels on which funding is based.
authors.affiliation: Richmond, Twickenham, and Roehampton Health Authority, Queen Mary's University Hospital, London.
authors.forename: J D
authors.initials: JD
authors.lastname: Williamson
mesh_terms: D002017:Budgets; D004630:Emergencies; D005194:Family Practice / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008131:London; D008511:Medicine; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D016079:Refusal to Treat; D013038:Specialization; D013222:State Medicine / Q000191:economics*