3.1.3 Over-referral and over-burdening services
In relation to the CFIR construct of patient needs and resources,10 there were concerns from some participants that additional referrals could over-burden services:
“It could be useful if the right patients are referred but it could also lead to over-referral as some people may have a certain risk but will not have cancer after they have been referred and tested ” (Service User 17: individual interview).
“But on the other side it will put a strain on the NHS; you know what I mean, on the services there. You know, you don’t want to over burden the services as well” (Practitioner 4 [GP]: individual interview).
In contrast, other practitioners felt that while there was a potential for over-referral, their use of clinical judgement alongside the tool to refer patients for investigations and specialists’ attention could reduce the potential for over-referral:
“But as we have said, we are not just referring but we are using our clinical judgements as well, so we would only refer those patients that need to be referred – so I don’t think there will be over-referrals” (Practitioner 1 [GP]: FG 3).