title: General practitioners' attitudes to variations in referral rates and how these could be managed.
abstract: BACKGROUND
  Hospital referral rates have received widespread attention for both clinical and economic reasons.
  
  
  OBJECTIVE
  This study was undertaken to find out the views of general practitioners in North Yorkshire on current arrangements for the feedback of routine referral data, perceived factors that influenced their referral behaviour and changes that might help their referral decisions.
  
  
  METHODS
  Survey questions were chosen from the issues raised during semi-structured interviews with 11 selected practices. A postal questionnaire was sent to all 114 general practices in North Yorkshire.
  
  
  RESULTS
  A 60% (68/114) response rate was obtained from the postal questionnaire. The majority of practices agreed that the referral information supplied by them was accurate (77%) and that the feedback of this data was useful (66%). Uncertainty of diagnosis/management and patient pressure were the two most commonly agreed factors that were suggested as influencing referral behaviour. Training in procedures and use of clinical guidelines were the most popular changes chosen as being helpful in referral decision making.
  
  
  CONCLUSIONS
  The feedback of routine referral data is considered accurate and useful, and should continue. Expanding opportunities for the training of general practitioners in specific skills and the development of clinical guidelines for the management and referral of commonly suggested areas would be helpful to general practitioners in making referral decisions.
authors.affiliation: Nuffield Institute for Health, Leeds, UK.
authors.forename: J
authors.initials: J
authors.lastname: Wright
authors.forename: J
authors.initials: J
authors.lastname: Wilkinson
mesh_terms: D003657:Decision Making; D004739:England; D005194:Family Practice / Q000458:organization & administration*; D005246:Feedback; D007722:Health Knowledge, Attitudes, Practice; D018578:Hospital-Physician Relations; D006801:Humans; D008511:Medicine; D010821:Physicians, Family / Q000193:education / Q000523:psychology*; D012017:Referral and Consultation / Q000458:organization & administration*; D013038:Specialization; D011795:Surveys and Questionnaires