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Concern over 'tidal wave' of GP referrals

PBC should be made an ‘emergency’ policy in light of alarming referral increases across the country, according to the NHS Alliance.

PBC should be made an ‘emergency' policy in light of alarming referral increases across the country, according to the NHS Alliance.

Latest figures from the DH show GP referrals for the first quarter of the financial year are up by 15.6%, compared with the same period last year.

Dr Mike Dixon, NHS Alliance chair, said the reasons for the ‘tidal wave' of increased referrals in some parts of the country were unclear (see box below). He added: ‘It makes PBC all the more of an emergency.'

Dr Dixon said: ‘In my own consortium referrals have gone up by more than 20% in mid Devon and I know that's about the average for the South-West.

‘It might be that as waiting times go down, referrals go up as more patients opt not to go private; or NICE guidelines are lowering the referral threshold.'

A spokesperson for NHS South West said some PCTs were showing a decrease and others an increase over the same period and that they were working with the DH to establish whether the numbers reflected an actual increase in patient referrals, or a problem with how data are recorded.

She added that the 18-week target had been achieved across the SHA – six months ahead of schedule.

Dr Nav Chana, NAPC executive board member, said increased referrals should not automatically be thought of as negative. He said: ‘The rise may simply be a reflection of GPs seeing more patients and so there is greater recognition of morbidity.'

Dr Chana said the figures strengthened the case for moving PBC along because measures to improve integration between primary and secondary care were far more likely to be successful than any incentive schemes to reduce referrals.

The increase in referrals also means PCTs are overspent on their commissioning budgets. Devon PCT overspent its budget by more than £4m between May and July and cited high GP referrals as a key reason.

Dr Dixon said: ‘This is the last call if there are elements in the system that are not allowing practice-based commissioners to get off the starting blocks.

‘There are GPs who are up for it but don't feel supported to go as fast as they want to go with PBC.

‘But the biggest issue is the one between the Government and the BMA. It means PBC is not being taken as seriously by GPs who feel alienated.'

Possible reasons for increase in referrals

• NICE lowering thresholds
• Consultants referring patients back to GPs rather than across to a different specialty
• Changes to OOH services – GP more likely to admit than ask a colleague to check in on a patient a few hours later
• Waiting lists going down so fewer patients choosing to go private
• 18-week target pressure
• Data problems
• GPs seeing more patients so greater recognition of morbidity

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