• J Emmanuel and N Walter.
• BMJ. 1989 Sep 16; 299 (6701): 722-4.

ObjectiveTo determine the appropriateness of referrals from general practice to hospital outpatient departments.DesignProspective audit of referrals from a group practice over one year.SettingSix handed practice in a southern coastal town.SubjectsAll patients referred during the study period for whom a copy of the referral letter was available.Main Outcome MeasuresThe investigations carried out by the consultant that led to the diagnosis; the diagnosis reached; and the management.ResultsOf roughly 3000 patients referred during the year, 277 with various skin and soft tissue disorders could probably have been managed solely by the general practitioner. Referrals for cryotherapy (96 in this series) and diabetes (19) could probably also have been avoided by specialist training of the general practitioner. In addition, in cases of haematuria and prostatic hypertrophy (34 and 22 referrals) substantial time could have been saved for both the patient and the consultant had the general practitioner supplied the results of relevant investigations. Probably the most important outcome was the model that the study offered for other general practitioners to improve the appropriateness of referrals.ConclusionThis approach to determining the appropriateness of referrals benefits the general practitioners, the consultant, and the patient.

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