Consensus study

The aim of this study is to establish criteria for the re-referral of stroke survivors.


There are currently no formal guidelines to determine when a stroke survivor should be referred out of primary care. This research aims to fill this gap by establishing guidance for referral of stroke survivors from primary care to secondary care. The findings from this study will inform the larger programme of research which aims to develop a new model of services for stroke survivors living in the community.


This consensus study aims to establish guidance to better enable health care professionals in primary care to make decisions about referral to specialist care, and will take the form of a two-stage modified RAND appropriateness method (as developed by the RAND Corporation).


We are using a two-stage RAND appropriateness method to establish consensus among stroke specialists and generalists to decide on the criteria for referral. Consensus methods seek to synthesise the opinions of a group of experts in a particular field. A 12 person panel will be selected by the study team. The make-up of this panel will consist of the following individuals: GPs, practice nurses, stroke physicians, stroke care co-ordinators and allied health professionals. Participants will be asked to rate patient scenarios on the need for any referral and the need for specialist stroke referral. The results from round 1 will be collated and analysed and the research team will revise scenarios where panelists had found them unclear. Additional scenarios may be added for the following round.

The second stage of the study will be a face-to-face meeting of all panelists. Each scenario will be discussed again, along with new scenarios and all will be scored or re-scored for whether specialist referral is required.


The expected outcome of this study is the production of guidance for management in primary care or referral back to secondary care or specialist services for stroke survivors.


  1. Lim L, Mullis R, Roland M, Mant J.M. Long-term care of stroke survivors: identifying circumstances in which referral to specialists may be beneficial using a modified rand appropriateness method. European Stroke Journal. 2018
  2. Lim L, Mant J.M, Mullis R, Roland M. When is referral from primary care to specialist services appropriate for survivors of stroke? A modified RAND-appropriateness consensus study. BMC Family Practice. 2020












“Patients and caregivers would benefit from active follow up and information provision about stroke that is tailored to their specific needs, which change over time”

– Jonathan Mant, Professor of Primary Care Research