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Cash-strapped PCTs order GPs to delay referrals

By Nigel Praities

Exclusive: GPs are being forced to delay referrals in specialities that have hit the Government's flagship 18-week target because they are performing too well, Pulse can reveal.

PCTs hit by a financial crisis caused by a jump in GP referrals are to impose strict limits in clinical areas that have ‘over-performed' on waiting times, in a desperate attempt to claw back cash.

The moves come as next month's Government deadline looms for all patients to start treatment 18 weeks after being referred.

But any fanfare over falling waits is likely to be muted by the ongoing referrals crisis. Pulse understands a Government investigation has pinpointed reduction in waiting time as a key reason for the 16% rise in GP referrals in the first quarter of this year.

Now PCTs are beginning to instruct their own commissioners and members of practice-based commissioning groups to begin making swingeing cutbacks in areas where referral-to-treatment waiting times are shorter than 18 weeks.

Manchester PCT, facing a £15m annual overspend on provider service agreements, said it was instructing GPs to take urgent steps to reduce spending, adding there was ‘no flexibility' to accommodate any further financial pressures.

It is ordering GPs to ‘investigate specialities where average waiting time has been reduced to the 18 weeks standard and take necessary action to reduce expenditure commitments'.

A separate report by NHS North West commissioning bosses claimed there was ‘increasing evidence to suggest pressures on the delivery of the 18-week target are changing GP referral behaviours' leading to contract overspending.

Dr Martin Whiting, a GP in Manchester and steering group chair of the PBC North Hub in the city, said he had yet to have formal discussions with the trust, but expected specialities with short waiting times to be asked to make patients wait longer for treatment.

‘We need to be more equitable about waiting lists. When specialities have a waiting time of five weeks that has an impact on the budget. This may mean spreading referrals out, which will probably mean delaying referring or seeing them.

‘This has been done before, when surgery was delayed until the following year. We are not suggesting going that far, but something like that.'

Elsewhere, Berkshire West PCT, which is facing an overspend in its hospital contracts of more than £3m, is another to clamp down.

It has identified three specialities where activity had shot up as a result of increased GP referrals: orthopaedics, dermatology and general surgery.

The trust said it was taking action to ‘ensure wait times are not significantly lower than the 18 week target and contributing to over-performance', and was working with GPs to ‘ensure referral and intervention thresholds do not change as a result of shorter waiting times'.

Dr Kailash Chand, a GPC member and a GP in Ashton-under-Lyne, Greater Manchester, said: ‘These initiatives to meet financial targets, we as clinicians want no part of. There needs to be a thorough investigation into the reasons behind the increase in referrals before we do anything.'

18-weeks clampdown: Dermatology, general surgery and orthopaedics all hit 18-weeks clampdown: Dermatology, general surgery and orthopaedics all hit

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