Management control of open-access radiology: is it possible?

This paper considers management options for limiting general practitioner use of open access radiology - a service for which there is increasing demand which is difficult to meet. In the current climate of cost containment, restriction of general practitioner access to these expensive diagnostic facilities has management appeal. However, it is difficult to justify blanket restriction of access to radiology services as there is no evidence that it would be economically or clinically sensible. An explicit quota system is unlikely to be feasible because of the small number of referrals made by general practitioners and the element of chance which will inevitably enter into the referral process. Managers should examine more closely the manipulation of incentives and costs which are used, often implicitly, to balance the conflicting desires of clinicians and managers. The best management option would appear to involve a re-evaluation of the role of the radiologist to include responsibility for managing the service. This should include assessment of appropriateness of referral by reference to guidelines for investigation and the behaviour of acknowledged good practitioners.