Referral Pathways

The study classified ED referral sources into six categories. Referral findings across CCNs were heterogeneous: CCN D achieved a significant reduction in colon cancer referrals (−3.6%), while CCN A showed a significant increase (+4.4%). Patients from the most deprived areas had substantially lower adjusted probability of GP referral than those from the least deprived areas. Ambulance use was higher among patients from more deprived areas after adjustment. Patients from the most deprived areas also had a lower adjusted probability of NHS 111 referral than those from the least deprived areas. CCN A's significant pancreatic cancer cost reduction was paired with a significant increase in double diagnostics, undermining a straightforward efficiency explanation. Double diagnostics were defined as an identical diagnostic activity performed within 4 weeks of referral to a secondary hospital. All four CCNs showed increases in double diagnostic activity for pancreatic cancer, but only CCN A's increase was statistically significant at +8.2%. Community self-referrals declined from 2023 to 2024 largely because capacity constraints led surge planning to block them on high-demand days. Referrals…