GPs told: Only send patients to hospital if other doctors agree
GPs have been banned from sending patients to hospital unless they have permission from other doctors.
The controversial scheme covers all non-urgent referrals – including requests for hip and knee surgery, cataract removal and X-rays and scans.
GPs must submit each referral to a panel of doctors, who will consider whether the procedure is both necessary and cost-effective.
Any case which is deemed inappropriate will be sent back to the GP and the patient refused treatment.
The pilot has been rolled out across two health trusts in north-east england which collectively serve 300,000 patients. Managers claim the measures will ease the pressure on local hospitals while ensuring NHS resources are spent wisely.
But senior GPs say the scheme is unsafe and will lead to vital referrals being delayed or rejected. Patients sent for non-urgent scans can later be found to have cancer, heart disease or other life-threatening conditions.
The scheme – uncovered by Pulse magazine – is being introduced this month across Darlington and Hartlepool and Stockton- on-Tees clinical commissioning Groups.
GPs have been asked to submit all non-urgent referrals to a panel of family doctors, called the clinical assessment and peer review service.
These doctors have no knowledge of the patient and will not have access to their medical notes. each case will be assessed over two days before being either approved or sent back to the GP with a suggestion of other treatments.
Although GPs will be able to appeal, this will only add to the delay. Dr Helen Stokes-lampard, chairman of the Royal college of GPs, said the scheme raised ‘patient safety concerns’.
‘Referral management systems are usually well-intended,’ she said. ‘But we need to see evidence that they are costeffective for the NHS, and that they are benefiting patients, before we roll them out widely. Unfortunately, in many cases this evidence is lacking.
‘We know that most ccGs are in a very difficult position trying to balance reducing income with soaring patient demand.
‘But the fear among GPs is that these referral schemes can actually create more work, and especially more bureaucracy, at a time when the profession is already snowed under.
‘We’re also concerned that these schemes can undermine the important trust that exists between GP and patient. in some cases, if decisions are made about patients in the absence of their full records, it raises patient safety concerns.’
Jenny chapman, labour MP for Darlington, said: ‘it seems extraordinary that experienced professionals are being told to use this system when their role is to use their own judgment.
‘i am not aware that there has been any huge issue with GPs making inappropriate referrals. if there is evidence of that, the right thing to do is have a dialogue with GPs.’
Professor Ahmet Fuat, a Darlington GP and professor at Durham University, said: ‘We are all being pressured to reduce spending in the NHS and that’s the reason behind this – for every referral we make, there is a charge.
‘Those deciding will not have access to patient notes, they will get a letter, check it against guidelines and either send it on as requested or send it back – that will cause a delay in the referral and for the patient.
‘ This is just one of many things that are happening where healthcare is being rationed by the back door.’
The NHS is facing an unprecedented level of demand and hospitals and health trusts have been instructed to rein-in their spending.
As a result, they are trying to ration the number of nonurgent procedures including hip and knee surgery, varicose vein repair, cataract removal and routine X-rays and scans.
if this latest scheme is successful in reducing referrals, it may be adopted by other health trusts.
A spokesman for Darlington and Hartlepool and Stocktonon-Tees clinical commissioning Groups said: ‘The clinical assessment and peer review service is based around similar systems which have shown to be of benefit.
‘We believe the system to be an effective financial model, given the increased quality of care the service will deliver.’
‘Profession is snowed under’