Gatekeeping in primary care: Analysing GP referral patterns and specialist consultations in the NHS

This study investigates the impact of increasing the number of gatekeeper General Practitioners (GPs) on referral rates and specialist treatments. Gatekeeping is a supply-side strategy implemented to control health expenditure and improve efficiency by limiting patient access to services below marginal cost. It aims to address specialist moral hazard by reducing the overuse of expensive diagnostics and replacing them with more cost-effective GP diagnostic information. Using administrative data from 2004 to 2011, we examine whether the availability of gatekeeper GPs in local areas is associated with changes in outpatient referrals and elective admissions. Our findings reveal that increasing GP supply in socioeconomically disadvantaged areas leads to a decrease in both outpatient referrals and elective admissions. However, these effects are less pronounced in prosperous areas or regions with high GP referral rates. Interestingly, we observe that having more GP practices in a specific area implies higher referral rates and elective admissions. These findings offer valuable insights that can assist policymakers in crafting targeted policies to effectively reduce healthcare costs and enhance the overall efficiency of the health system. • GP gatekeeping can improve healthcare efficiency in single-payer systems. • Model shows GPs balance own interests with maximizing population health gains. • Increased GP supply leads to fewer specialist referrals and treatments. • Effect of GP supply on referrals is more pronounced in deprived areas. • Study reveals trade-off between healthcare efficiency and social welfare.