30 Jul 2026
The CMA investigation and the ongoing professional guidance of the RCVS has highlighted the importance of transparency, communication and professional collaboration throughout the referral process. Referral is no longer viewed solely through the lens of clinical excellence; it is increasingly judged by the quality of the overall experience delivered to both the referring vet and the pet owner…
Mayank Seth
Job Title
Image: gpointstudio / iStock
At its core, the role of a referral clinic is straightforward: to provide expertise, facilities or treatment options that are not readily available within first opinion practice. In theory, this is achieved through investment in advanced equipment and the recruitment of experienced clinicians, nurses and support staff. In reality, referral medicine introduces a number of additional operational and interpersonal complexities.
Referral centres receive animals that have already been assessed and treated elsewhere, often during periods of considerable emotional stress for owners and clinical uncertainty for the veterinary team. This can create sensitivities around perceived failure or criticism of previous management, even where no such criticism is intended. Cases are frequently unstable, emotionally charged and financially demanding. Longer hospital stays and larger multidisciplinary teams increase the number of interactions that must be coordinated effectively.
When reviewing online feedback relating to UK referral centres, several recurring themes emerge. Clinical expertise and facilities are commonly praised. However, negative reviews frequently focus on communication failures, misunderstandings regarding cost, or a perceived lack of compassion. Importantly, these complaints often arise not from poor medicine, but from poorly managed expectations and communication failures.
A successful referral centre therefore requires more than clinical excellence alone. It must consistently deliver expertise, compassion, value and communication.
Expertise is the foundation upon which referral practice is built. Many referral clinicians have undertaken extensive postgraduate training, and in many cases this results in recognition by the RCVS as an advanced practitioner or specialist. For both referring vets (RVs) and clients, clarity regarding the level of expertise available is essential.
Referral decisions are often made by balancing competing priorities including expertise, distance, waiting times, availability, facilities and cost. Understanding the qualifications, experience and scope of services offered by a referral centre allows both the RV and the owner to make informed decisions appropriate to the patient’s needs.
Equally important is recognising the professional relationship between the referring practice and the referral centre. Referral should not be viewed as a transfer of responsibility away from the first opinion practice, but rather as a collaborative extension of care. The most successful referral relationships are those built on mutual respect and open dialogue between clinicians.
Compassion is often assumed within the veterinary profession, and rightly so. Most individuals working within veterinary medicine are highly motivated by animal welfare and client care. However, compassion is not always experienced consistently by clients, particularly in large or pressured referral environments.
Referral centres can appear intimidating to owners. They are often larger, busier and more technologically complex than first opinion practices. Clients may encounter multiple clinicians, nurses, receptionists and finance staff during a single visit. They are also commonly attending under stressful circumstances involving uncertainty, emergency presentations or difficult prognoses.
In these settings, compassion is communicated less through intent and more through behaviour. Small details become highly significant: clear introductions, timely updates, empathy during financial discussions and consistency of messaging between team members.
Compassion fatigue can also affect team performance. Poor workplace culture, excessive workload and chronic stress reduce the ability of staff to communicate empathy effectively. Conversely, supportive workplaces with engaged teams are more likely to foster compassion satisfaction, where staff derive fulfilment from delivering high quality care and communication.
Clients rarely have the expertise to judge clinical decision-making in detail. They are, however, acutely aware of how they are made to feel throughout the process. This means that operational systems, staff well-being and communication training have a direct impact on client perception of care quality.
Cost remains one of the most contentious aspects of referral medicine. Advanced imaging, specialist surgical procedures, intensive monitoring and prolonged hospitalisation are inherently expensive to provide. However, owners frequently enter the referral process with limited understanding of likely costs or the potential for plans to evolve as investigations progress.
The CMA has placed considerable emphasis on price transparency within veterinary services. In the referral setting this presents unique challenges because no two cases are truly identical. Definitive diagnoses are often not established at the point of referral, making precise estimates difficult.
Nevertheless, uncertainty should not become a barrier to transparency. Referral centres that communicate proactively regarding likely costs, ranges of expenditure and potential contingencies are generally more successful at maintaining client trust.
Many centres now publish fees for standard services on their websites, including consultation charges, imaging procedures and hospitalisation costs. Providing estimate ranges for common presentations can also be helpful. Although such figures cannot account for every eventuality, they allow owners to begin financial planning before committing to referral.
Communication between the RV and the referral clinician also plays an important role. Experienced first opinion clinicians often develop a practical understanding of the relative costs associated with different referral providers in their region. Open professional dialogue regarding expected costs, availability and likely treatment pathways allows more informed conversations with clients prior to referral.
Importantly, discussions regarding value should extend beyond price alone. Owners are frequently balancing financial considerations against travel distance, continuity of care, expertise, waiting times and emergency availability. Different clients will prioritise these factors differently. The CMA’s recommendation that owners be offered appropriate referral choice reflects the importance of aligning referral decisions with individual client priorities.
As George Bernard Shaw famously observed: “The single biggest problem in communication is the illusion that it has taken place.” This observation remains highly relevant within modern referral practice where communication is arguably the single most important determinant of success. The referral process involves a complex triangular relationship between the client, the RV and the referral centre. Failures at any point within this network can lead to frustration, delayed care, damaged professional relationships or compromised patient outcomes.
Referral centres therefore need to communicate clearly not only about individual cases, but also about how their service operates overall. This includes clarity regarding:
Mismatch of expectations is one of the commonest causes of dissatisfaction. Owners may assume 24-hour on-site specialist care when overnight provision differs. RVs may expect ongoing management to remain with the referral centre when discharge plans assume primary care involvement. These misunderstandings are rarely malicious; they are usually failures of clarity.
Communication occurs repeatedly throughout the referral journey. The initial referral request may arrive via telephone, email, online portal or increasingly through integrated referral platforms within practice management systems (PMS). Effective referrals require comprehensive information including clinical history, diagnostics, medication details, owner contact information and the specific reason for referral. A standardised form allows this information to be collected efficiently and comprehensively.
Administrative communication with clients is equally important. Appointment confirmations, preparation instructions and admission details must be timely, professional and accessible. Most modern PMS systems allow automation of much of this process, but the attention to situation-dependent content is key. Communication methods must also reflect modern client expectations. While telephone communication remains essential in many circumstances, owners increasingly expect email, SMS messaging or app-based communication options.
The consultation itself represents another critical communication point. Owners require clear explanations regarding diagnostic plans, treatment options, risks, prognoses and likely costs. Consent discussions should be structured, documented and realistic. Financial conversations, including insurance considerations and deposit requirements, should be handled sensitively and transparently.
Communication during hospitalisation has become an increasingly important aspect of referral care. Owners separated from hospitalised pets often experience significant anxiety. Regular updates – whether by phone, text message, email or even short video clips – can greatly improve reassurance and trust. Electronic communications, including summaries of verbal conversations, allow clients to reflect on material and share it within their family groups, allowing shared decision making and reducing anxiety for all involved.
Communication back to the RV is equally vital. Discharge summaries and treatment reports should be prompt, concise and clinically useful. The RV often resumes responsibility for long-term management shortly after discharge, making timely information transfer essential. A difficult balance must be struck regarding communication with the RV in many regards.
Information must be rapidly transferred and so should be concise enough to be assimilated easily, but enough information must be provided to give a thorough understanding of the case and the clinical decision-making to date, as well as the ongoing plan.
In many cases, there are results pending at the time of discharge meaning that any communication at that time is necessarily incomplete, but nonetheless important so that all parties are up to date. Where there is feedback to be given about the case management, it is important that this is clear but equally important that it is provided in a constructive and blame-free manner.
Long-term relationships based on trust and respect are the cornerstone of smooth referrals, making it important that the communication between parties is honest but friendly. Ongoing three-way communication may continue for weeks or months following referral; medication adjustments, laboratory interpretation and modifications to treatment plans frequently require coordinated discussion between all parties.
A further critical dimension is internal coherency across the referral business. All members of the clinic team – including clinicians, nursing staff and administrative personnel – must operate within a shared and clearly understood communication strategy.
Consistency is essential so that RVs and clients receive predictable, reliable interactions regardless of who they speak to. Equally important is clarity around individual roles within the communication chain, ensuring that messages are appropriately escalated and directed to the right person without delay.
While rapid responsiveness is an operational advantage in referral medicine, speed without coordination can be counterproductive; for example, administrative acceptance of emergency referrals without real-time clinical awareness of capacity or staffing may undermine RV trust, compromise client expectations and, in some cases, adversely affect patient care. Effective internal communication systems therefore underpin not only efficiency, but also clinical safety and professional credibility.
Communication methods have evolved dramatically over the past two decades. Historically, client communication was largely verbal, while referral reports were commonly transmitted by post or fax. Today, clients and veterinary professionals operate within a far broader communication ecosystem including email, messaging platforms, websites, video calls and integrated digital systems.
Not every method is appropriate in every circumstance. Effective communication requires consideration of several factors including urgency, permanence, detail, confidentiality and client preference.
Different individuals assimilate information differently. Some owners may strongly prefer telephone conversations, particularly when discussing emotionally difficult updates. Others may value concise text messages during busy working days. Detailed discharge instructions are often better provided in written form so they can be reviewed later. Providing different communication options to clients is vital to meet client demand and improve accessibility for those with specific needs.
The same principles apply to professional communication between practices. Standardised referral forms are efficient for routine cases because they ensure consistency of information gathering. However, urgent referrals often require direct telephone discussion to confirm availability, urgency and immediate management priorities.
Real-time communication methods such as telephone calls or secure messaging platforms allow dynamic case discussion and clarification. Email permits transmission of more extensive information without requiring simultaneous availability, but may lack the efficiency of live discussion for complex or evolving cases.
Successful referral centres recognise that communication strategy should remain flexible rather than rigidly standardised.
Modern referral practice generates substantial volumes of communication across multiple channels. Without robust systems, information can easily become fragmented or overlooked.
Integrated PMS platforms are increasingly central to managing this complexity. Modern systems can consolidate emails, messages, clinical notes, imaging reports and referral correspondence into unified patient records. Many also integrate directly with dedicated veterinary communication platforms via application programming interfaces (APIs).
These systems improve continuity, reduce duplication and help ensure that communication remains visible to all relevant team members. However, they also introduce responsibilities relating to cybersecurity, staff training and compliance with GDPR requirements.
Artificial intelligence (AI) tools are also beginning to influence referral communication workflows. Standardised templates may improve consistency of tone and structure while reducing administrative burden on clinicians.
Potential applications include:
These technologies offer considerable efficiencies, particularly within busy multidisciplinary hospitals. However, caution remains essential. AI-generated content must still be reviewed for accuracy, completeness and appropriateness.
Data handling and confidentiality also remain critical considerations, particularly where external software platforms are involved. Encouragingly, veterinary-specific AI tools are now emerging that are designed with appropriate linguistic training and GDPR compliance in mind.
Referral medicine represents one of the most collaborative areas of veterinary practice. Clinical expertise remains fundamental, but expertise alone is insufficient to create a successful referral service.
Modern referral centres must also excel in communication, transparency and relationship management.
The referral process involves multiple stakeholders operating under emotionally and financially challenging circumstances. Clear expectations, timely updates, respectful professional collaboration and compassionate client interactions are therefore essential components of quality care.
As regulatory scrutiny and client expectations continue to increase, referral centres that invest in communication systems, staff well-being and integrated technology will be best positioned to maintain trust with both referring practices and pet owners.
Ultimately, successful referral practice is not simply about providing advanced medicine. It is about ensuring that complex care is delivered through equally sophisticated professional relationships.
Mayank Seth is a small animal internal medicine specialist and managing director and founding partner of Stansted Veterinary Specialists.