Risks with referrals
Alison Large, dento-legal adviser at the DDU, advises on reducing the risks associated with the patient referral process.
The making and receiving of patient referrals, for example to a colleague with greater or more relevant expertise or, the delegation of a task to an appropriately trained member of the dental team, is part and parcel of everyday practice.
Unfortunately, the process can and does give rise to patient complaints and claims. However, by following a few basic principles you can help manage the risk of problems occurring.
The importance of communication
Among the key principles in managing a referral is excellent communication and record keeping. The GDC’s Standards for the Dental Team states that: ‘You should provide patients with clear information about any referral arrangements related to their treatment’ (standard 2.3.11), and that: ‘If you refer a patient to another dental or other health professional, you must make an accurate record of this referral in the patient’s notes and include a written prescription when necessary’ (standard 4.1.6).
Make sure patients understand the reasons for the referral and that they have all available options presented to them including NHS or private, the person or organisation to whom the referral is to be made, any costs involved and a realistic indication of the timeframe.
The GDC’s standards also say that you mustn’t mislead patients into thinking that NHS-available treatments can only be provided privately (standard 1.7.3) or, as standard 1.7.4 states, pressurised into having private treatment if it is available to them under the NHS (or equivalent).
Consequently, ensure that all advice given is accurate and up-to-date as a failure to do so may leave you open to allegations of being misleading or even dishonest. For example, where a patient is to be referred for molar endodontics, it is essential to have up-to-date knowledge of the local referral options. Reliance on anecdotal information or an assumption that there is no NHS provision can be risky, as the commissioning of such services may change from time to time and from area to area.
Practices can double-check their information by contacting their NHS Primary Care organisation and referral centres for written confirmation about referral options, criteria and protocols, and ask that they be updated when there are any changes. In this way colleagues can be confident that patients are not inadvertently given inaccurate information at the time of referral.
To help avoid patient complaints, those working under NHS arrangements need to understand and carefully apply the current rules and regulations surrounding governing referrals.
It is important that colleagues and organisations accepting referrals proactively provide such information to their referring practices. To do so helps to manage patient expectations, avoid inappropriate referrals and reduce the risk of patients being frustrated at having waited for an appointment only to find that they cannot be seen and treated.
The GDC requires that colleagues communicate and work effectively as a team in patients’ best interests. Practices should have protocols in place so that all team members understand their roles and responsibilities within the referral process. This can help ensure it runs efficiently and, as far as is possible, reduces the risk of a delayed referral, with its potentially serious attendant consequences.
Protocols between practices and other organisations should be clear. For example, where referrals are made for imaging, we would suggest it is the responsibility of both the referring clinician and the professional accepting the referral to be clear on whether the patient is being referred for the radiographic exposure alone, with the images to be reported by referrer, or both the radiographic exposure and a report on the images.
You should avoid offering or accepting referral fees as the GDC standards state that:
- You must always put your patients’ interests before any financial, personal or other gain
- You must refuse any gifts, payment or hospitality if accepting them could affect, or could appear to affect your professional judgement
- Referrals must be made in the patients’ best interests and not for your own or another team member’s financial gain or benefit.
As patients’ expectations and the ever-increasing range of treatments available continue to grow it is likely that practices will see an increase in the need for both internal and external referrals. Careful attention to detail in terms of communication between clinician and patient, colleague to colleague, record keeping and adherence to up to date protocols will all contribute to risk management of the process.
For more information visit www.theddu.com or call 0800 374 626.