How Service Agreements Can Improve Referrals and Shrink the Medical Neighborhood


Defining expectations with consultants can make referrals easier for both you and your patients.

Fam Pract Manag. 2018 Sep-Oct;25(5):18-22.

Author disclosure: no relevant financial affiliations disclosed.

Family medicine practices are the “home” for most of our patients' health care needs. Sometimes, of course, our patients need the expertise of more specialized physicians, which means sending our patients out into the wider “medical neighborhood.” This journey can be risky because of the lack of coordination among the fragmented medical team. This often results in duplicative tests, unnecessary treatments, and conflicting recommendations between one physician and another.

As our patients' family physicians, it is our responsibility to ensure that they have coordinated care when we provide referrals so that they receive efficient, high-quality medical treatment and seamless transitions of care. This is an important role for family physicians, whether we practice in a free-standing primary care group referring to the consultants across town, as I do, or as part of a large health care organization referring to the consultants down the hall. The issues that occur between family physicians and consultants are largely the same.

For the past 10 years, our practice has used service agreements to facilitate the complex relationships between family physicians and consultants. A service agreement is a written document — not a contract — negotiated between the primary care practice and an individual consulting specialty practice that defines the expectations of referrals between the two offices and clarifies common issues such as urgent access to the consultant and timely exchange of information. This article will discuss why these agreements are helpful and how to develop them for your practice.


  • A service agreement is a written document outlining the patient referral expectations between a family medicine practice and a consultant practice.

  • Key issues include how to access the consultant in a timely manner, what information each party should provide, and who is responsible for which parts of a patient's care.

  • Service agreements should develop through physician-to-physician conversation, not through go-betweens.


The goal of the service agreement is to create a “warm handoff” between the family physician and the consultant. Both the patient and the family physician benefit from this, because a warm handoff reinforces the patient's trust in our judgment, helps build the patient's relationship with the new physician, and sets the stage for more effective care.

There are three key elements to ensure a warm handoff for every referral:

  1. Collegial relationships. Given physicians' busy schedules, informal peer-to-peer discussions about individual patients are not always possible. But the potential for conversation between the primary care physician and the consultant should always exist — especially when the patient has a com


Dr. Safford is a family physician and the medical director of quality for Family Care Network in Whatcom County, Wash.

Author disclosure: no relevant financial affiliations disclosed.


Copyright © 2018 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz


Jul-Aug 2019

Access the latest issue
of FPM journal

Read the Issue

FPM E-Newsletter

Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights."

Sign Up Now