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Table 1 Characteristics of participating referral management centres and interviewees

From: Referral management centres as a means of reducing outpatients attendances: how do they work and what influences successful implementation and perceived effectiveness?

RMC

Key features

Interview number

Interviewee characteristics

Role in RMC

A

Functions: Clinical triage by GPs with additional expertise and allied health professionals; reviews referrals from 30 specialties; referrals either diverted to community service, returned to GP with advice or sent on to acute trust; manages patient bookings through 'choose and book' process; provides individual level advice and guidance to GPs, monthly referral reports and live access to referrals data; broader educational function

Organisation: Provided by existing out-of-hours provider and software specialist; covers 3 CCGs, 95+ practices, 70 000 referrals; practices pay based on patient list size; operating 2010-present; patient booking originally provided out of area but now commissioned locally

A1

GP with managerial responsibility, director of RMS provider organization

Set-up and running

A2

Manager, CCG

Commissioning

A3

2 managers (joint interview), RMS provider

Set-up and running

A4

GP

User only

A5

GP

User only

B

Functions: Clinical triage by GPs; referrals either diverted to community service, returned to GP with advice or sent on to acute trust; reviews referrals from selected specialties; manages appointments booking (not linked to 'choose and book'); collects data to inform commissioning; limited individual level feedback; educational sessions and newsletters

Organisation: Provided by existing out-of-hours provider; covers 1 CCG, 70+ practices; funded by CCG - cost per letter triaged; operating 2010-present; began as purely administrative with later introduction of GP triaging

B1

Manager, CCG

Running

B2

GP with managerial responsibilities

Commissioning/set-up

B3

GP with managerial responsibilities

Running and user

B4

GP with managerial responsibilities

Development, running and user

B5

GP with managerial responsibilities, also employed by RMS provider

Set-up and running, GP triager and user

B6

GP

User only

C

Functions: No clinical triage by RMC staff; consultant triage commissioned from secondary care; following consultant triage referrals to selected specialties diverted to community service, returned to GP with advice or accepted by acute trust; non-clinical staff at RMC manage patient bookings through ‘choose and book’ and the process of sending referrals for selected specialties for consultant triage; collects data to inform commissioning; data reports at GP/practice level; internal peer review and educational sessions

Organisation: Provided by existing educational services provider; covers 1 CCG, <20 practices; funded by CCG - unit cost per triaged and non-triaged referral; operating 2012-present; began as purely administrative with later introduction of consultant triage element

C1

Manager, RMS provider organization

Set-up and running

C2

Manager, CCG

Commissioning and set-up

C3

GP with managerial responsibility

Set-up, running and user

C4

Practice Manager, also involved in management of RMS provider organisation

User, set-up and running

D

Functions: Clinical triage by GPs and nurses under supervision; focus on changing referral behavior through feedback and education; no diversion of referrals, GP retains responsibility for referral destination; no management of patient bookings; collects rich data; provides individual level feedback on referrals, weekly ‘top-tips’, access to detailed referral data; broader educational function

Organisation: Provided by CIC set up specifically to deliver RMS; covers one CCG, opt in required – 16/24 participated; operating 2010–2013 – contract not continued.

D1

Manager, RMS provider

Set-up and running

D2

GP with managerial responsibility, CCG

Commissioning

D3

GP, also employed by RMS provider

GP triager and user