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BMC Proceedings

Open Access

Irish GP referral rates and influencing factors

  • P Gouda1,
  • C Mahambo1,
  • C Eamonn2,
  • L Glynn1 and
  • G Glynn1
BMC Proceedings20159(Suppl 1):A14

Published: 14 January 2015


Emergency DepartmentGeneral PractitionerHealthcare SystemSecondary CarePatient Consultation


General practitioners (GPs) play a key role as the gatekeepers of access to secondary care in Ireland, and indeed in many healthcare systems worldwide [1]. This role has been shown to be crucial in providing cost-effective healthcare delivery. Our study aimed to analyse the GP referral process and the factors by which referral rates may be influenced, particularly those that are unique to the Irish healthcare system.


Eighty GPs of the County Sligo General Practitioners’ Society participated between July 2011 and November 2011. For 100 consecutive patient consultation each GP record: patient age, gender, GMS status, and whether or not the patient was referred. In the case of a referral, the GP was asked to specify to what specialty they were referred. Statistical analysis was conducted using PASW Statistics 20.0.


Of the 7993 consultations, 936 (11.7%) patients were referred to secondary care. There was a wide spectrum of GP referral rates, ranging from 1% to 26%, with a mean average GP referral rate of 11.7% +/- .72%. The emergency department received the greatest proportion of GP referrals (25%). GMS eligibility was found to be associated with referral rates, with 9.7% of GMS eligible patients referred to secondary care compare to 15.3% of GMS ineligible patients, OR 1.67 (95% CI 1.45-1.92). GP gender was also associated with referral rates, with female GPs having a referral rate of 13.2% +/- 6.1 compared to male GPs at 10.4% +/- 6.5 (p = 0.016).


Our study demonstrates a wide range of GP referral rates. Rather than attempting to standardise referral rates, studies suggest we should strive to reduce inappropriate referral rates [2]. As a result, future studies should aim to measure both the appropriateness of referrals as well as the outcomes of the referral. Although studies of this sort have been conducted in the UK, they have yet to be reproduced in Ireland.

Authors’ Affiliations

National University of Ireland, Galway, Ireland
Ark Medical Centre, Unit 1B, Letterkenny Town Centre, Letterkenny, Ireland


  1. Brekke KR, Nuscheler R, Straume OR: Gatekeeping in health care. J Health Econ. 2007, 26 (1): 149-70. 10.1016/j.jhealeco.2006.04.004.View ArticlePubMedGoogle Scholar
  2. O'Donnell CA: Variation in GP referral rates: what can we learn from the literature?. Fam Pract. 2000, 17 (6): 462-71. 10.1093/fampra/17.6.462.View ArticlePubMedGoogle Scholar


© Gouda et al; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.