Referrals are an import part of a GPs working life, the traditional role as a “gatekeeper” to onward investigation and treatment is recognised as an integral part of the NHS – the current structure could not function without it. The referral letter is an important document, it expresses the GP’s thoughts regarding a patient’s problem as well as detailing important aspects of the past medical history of the patient. A referral letter with the appropriate information enclosed enables secondary care to prioritise or triage the referral, which is in the patient’s best interests, as well as relieving pressure on the service.  This resource suggests methods by which a doctor may examine his/her referral pattern and quality. The aim behind this section is to encourage individuals to think about their referrals, whether anything could have been done differently and to identify areas for further study. An individual may wish to use part or all of the resource sometime over a five year cycle.