the people who refer everything are usually those who are the juniors (MOPEX), or those who are not well trained (no further training in FM), or the old school GPs who are only comfortable managing basic level of conditions.

within the institutions, with greater level of collaboration between the specialists and FM, more of the care is being shifted towards the community (which really makes the job of FM much harder, imagine all specialties shifting some of the load to FM).

there will always be some degree of referrals needed. but once care has stabilised patients should be decanted back to the community. the cost savings is not just in the number of referrals, but the overall management of the patient.