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Almost half of GPs say delays caused by referral management schemes have harmed patients

Exclusive: Patients have been left in 'unbearable' pain while waiting for surgery because of delays incurred by local referral restrictions, GPs have reported. 

The second part of Pulse's two-week investigation into NHS rationing reveals nearly half of GPs believe patients are suffering as a result of delays caused by referral management schemes, with some patients going on to develop serious complications.

Of 252 doctors who responded to Pulse's survey, 44% said their patients had experienced adverse impacts from delays caused by local schemes over the past year, while only 35% said patients had not suffered.

Reports from around the country included patients facing ‘unbearable' delays on hernia surgery, a delay in the diagnosis of a baby with significant visual problems, and a patient who developed a carcinoma after being blocked from receiving an oesophagogastroduodenoscopy.

Dr Tim Cantor, a GP in West Malling, Kent, said a patient developed ‘severe cholecystitis requiring hospital admission for IV antibiotics' as a result of not being referred for gallstones in line with PCT policy.

Dr Bob Bowes, chair of West Kent CCG, said current criteria were for patients to experience two acute episodes, treated in primary or secondary care, before gallbladder removal, to get a ‘consistent, equitable service'.

A GP in Bangor, Wales, who asked not to be named, claimed his referral centre had cancelled referrals without telling his patients. ‘The patient will be waiting, thinking they're going to be seen and they're not,' he said.

A spokesperson for Betsi Cadwaladr University health board said: ‘Where it is identified that a referral would not offer any benefit to the patient, the GP is advised of this.'

Dr John Hughes, honorary secretary of Manchester LMC, said GPs were being blocked from referring patients who need gastric banding by restrictions in excess of NICE guidance, with referrals considered by the ‘effective resources team'.

‘We have to refer four times when we've given clear clinical reasons why the procedure is necessary,' he said. ‘It can take up to a year and these patients may develop diabetes or suffer a cardiac arrest in that time.'

NHS Manchester said patients could apply under ‘exceptional circumstances' if they fell outside eligibility criteria. 

The survey also found 61% of GPs had witnessed an increased use of non-doctors to review their referrals in the past 12 months.

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