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The current referral practice leads to resources being wasted in the health service

​The Office of the Auditor General's investigation shows that more than one in four GPs regularly refers patients to the specialist health service, even if they do not expect any medical benefit from it. At the same time, every third hospital doctor admits that they regularly take in patients for examinations even if it is clear on the referral that the patient should not have been referred. – Such a use of resources involves the risk of patients who need treatment having to wait longer than necessary, says the Auditor General Per-Kristian Foss.

Published 1/16/2018 1:00 PM

​Document 3:4 (2017–2018) The Office of the Auditor General's investigation into the authorities' work to ensure good referral practice from GPs to the specialist health service was handed over to the Norwegian Parliament on 16 January 2018.

The objective of this investigation has been to assess whether the authorities facilitate good referral practice from GPs to the specialist health service to ensure good use of resources.

During the investigation, 650 hospital doctors who assess and prioritise referrals within selected fields and almost 700 GPs have filled in questionnaires. Between 80% and 90% of hospital doctors regularly find that referrals from GPs do not include the required information and 50% of hospital doctors regularly find that the referral does not clearly state why the patient requires specialist treatment.

– Most GPs write good referrals, but some doctors stand out for negative reasons, states the Auditor General Per-Kristian Foss. – There is often insufficient cooperation between GPs and hospital doctors when making referrals and in many cases, GPs and hospital doctors have a different understanding of what information is required in a referral, Foss points out.

When information is missing from referrals, this can have consequences for both prioritising patients in the specialist health service and for the necessary treatment starting at the correct time. 40% of hospital doctors are, for example, worried that they prioritise incorrectly based on the referrals.

– It is necessary to reduce this uncertainty by increasing the quality of the referrals and, to a greater degree, adapting them to the specialist health service's needs, emphasises Foss.

Even if the GP regulations give municipalities clear responsibility for ensuring good referral practice from GPs, the investigation shows that many municipalities do not believe that they have such responsibility.

– The Ministry ought to examine how it can support the municipalities better in this work, says Foss.

The municipalities and specialist health service have a joint responsibility to offer services to persons with psychiatric disorders. Two out of three GPs believe that GPs and hospital doctors have a different understanding of when there is a need for specialist health services within psychiatric health care. Just as many hospital doctors who work in psychiatric health care are of the same opinion. This implies that it is unclear what conditions actually give this patient group the right to specialist health services.

According to the Office of the Auditor General's investigation, the fact that the municipalities and health enterprises have not sufficiently clarified how the offer to this patient group can best be arranged is a highly serious matter, says the Auditor General.

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