Identifying variation in GP referral rates: an observational study of outpatient headache referrals.

ObjectiveTo identify GP surgeries with unexpected rates of referral to specialist services, using headache referrals to outpatient neurology as an example. Identifying surgeries with unexpectedly high or low referral rates allows for further investigation and potential support to be targeted where it is most likely to be effective. MethodsThis is a retrospective observational study using routinely collected and open-source data. Data was collected from a single consultant outpatient neurology clinic and 202 GP surgeries across seven CCGs in the Northwest of England. The number of headache referrals from each GP surgery during a study period of 3 [1/4] years was used as the primary outcome in a poisson model. The standardised residuals from this model were then used to identify GP surgeries that were likely to have referred unexpected patient numbers for headaches to an outpatient neurology clinic during the study period. ResultsWe identified four GP surgeries with unexpected numbers of referrals. This model also showed that there were two main predictors of headache referral, namely other neurology referrals and the distance of the GP surgery from the outpatient clinic. ConclusionGP surgeries with unexpected numbers of referrals to specialist services were identified using a flexible methodology. This methodology was demonstrated using headache referrals but could be adapted to any type of referral or geographical area.