Extra-contractual referrals abolished

From 1948 onwards, GPs had the right to refer patients to out of area hospitals. For example, many patients from South Wales were referred to the Royal Brompton Hospital in London for cardiac surgery.

In parallel to the introduction of the internal market, extra contractual referrals (ECRs) were introduced from 1991. ECRs occurred when GPs referred patients to providers outside of the block contracts for consultant and hospital services for emergencies and some elective tertiary and secondary care services.

However, there were concerns over the disproportionate level of bureaucracy surrounding ECRs, as well as the uncertainty for health authorities which had to set aside money for such referrals.

In 1998, it had been pointed out in Parliament that the number of out of health authority area referrals between 1998 and 2000 had increased significantly. 23% of total referrals were out of area and 6.8% were out of region.

From April 1998, rules for GPs seeking authorisation from their health authority for ECRs were relaxed. The intention was to reduce administrative burdens on the latter.

Shortly afterwards, in 1999, ECRs were abolished. It was argued that this was to prevent GPs from making referrals to consultants and hospitals not selected by their primary care groups (PCGs).

In place of ECRs, the government introduced out-of-area treatments (OATs). These arrangements were only for people who needed emergency treatment while they were away from home. This move restricted the right of GPs to refer patients to any consultant and hospital.


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