title: Does the North Staffordshire slot system control demand of orthopaedic referrals from primary care?: A population-based survey in general practice.
abstract: BACKGROUND
  Attempts to manage general practice demand for orthopaedic outpatient consultations have been made in several areas of the NHS, with little robust evidence on whether or not they work.
  
  
  OBJECTIVE
  To evaluate the effect of the North Staffordshire 'orthopaedic slot system' on the demand for general practice referrals to orthopaedic outpatients.
  
  
  METHODS
  A prospective study of 12 general practices in the slot system, 24 controls, and the 63 other general practices in North Staffordshire. Comparison periods were the baseline year (0); the first calendar year (1); and the first half of the second calendar year (2). A multifactor linear regression model was used.
  
  
  RESULTS
  Mean referral rate decreased 22% in the slot group in period 1, and was maintained in period 2 (9.40, 7.29, 7.31 referrals per 10,000 population per month for periods 0, 1 and 2, respectively). The control and other groups showed a small decrease in period 1, but in period 2 higher referral rates were observed. The reduction in referrals of 20-40% in participating practices compared to other practices equates to 2-4 referrals per 10,000 patients per month.
  
  
  CONCLUSIONS
  Our study suggests that practices willing and able to take up an offer of a slot system for managing their orthopaedic referrals will be able to significantly reduce referral rates for their patients when compared to similar practices who do not. Further research on the generalisability, effectiveness and cost-effectiveness of such systems is warranted.
authors.affiliation: Keele University, Keele. Stephen.bridgman@northstaffs.nhs.uk
authors.forename: Stephen
authors.initials: S
authors.lastname: Bridgman
authors.forename: Xuefang
authors.initials: X
authors.lastname: Li
authors.forename: Gilbert
authors.initials: G
authors.lastname: Mackenzie
authors.forename: Peter
authors.initials: P
authors.lastname: Dawes
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D004739:England; D005194:Family Practice / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D008137:Longitudinal Studies; D009985:Orthopedics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*