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GP referral crackdown leaves cancer patients 'at home undiagnosed'

By Ian Quinn, Nigel Praities

The increasing use of GP referral management schemes is leading to patients with cancer 'sitting at home undiagnosed', a hospital's medical director has warned NHS clinical leaders.

Speaking at the NHS Medical Directors' Conference in London, Robert Talbot, medical director for Poole Hospital NHS Foundation Trust, launched a scathing attack on the referral management scheme launched by his local PCT in a bid to slash its secondary care spending.

‘It's quite clear that the number of colorectal cancers is going down,' he told the conference, adding it was ‘because there are patients sitting at home undiagnosed.'

The controversy came as national figures today revealed GP referral rates have started to rise again, a development likely to cause widespread panic at PCTs across the country already preparing for financial cutbacks, and likely to pile more pressure on GPs to slash referrals.

The row also comes just weeks after Gordon Brown unveiled plans for GPs who have any doubts about whether a patient has cancer to be able to have access to the relevant diagnostic tests within two weeks of the first appointment.

Bournemouth and Poole PCT has seen GP referrals soar by 12 per cent year on year according to the latest figures, for the second quarter of 2009.

Just this week it agreed to ratchet up the pressure on GPs to reduce referrals, saying that if they failed to bring down referral rates it would be forced to cut primary care budgets next year.

Dr Graham Archard, a GP in Christchurch, Dorset and a member of Dorset LMC, said he did not believe GPs would allow their referrals for potentially life threatening conditions to be influenced by referral management schemes.

He said: ‘I would like to see the evidence for this reduction but if it is true and it has been brought about by referral management I would abhor it - it would be an absolute disgrace.'

However, Dr Archard said it was right that PCTs and GPs should try to better manage referrals, although he said he was vehemently opposed to targets being set which would see GPs paid more for referring less.

The latest national figures from the Department of Health show that GP referrals continue to rise, up 8% in quarter two of this financial year – July to September – compared with the same period last year. This is an increase on the previous quarter's figures – April to June – that showed a 6% rise in GP referrals compared with the same period in the previous year.

PCTs around the country have already sought to introduce controversial incentive schemes after a shock 16% rise in referrals last year.

One controversial incentive scheme in Oxfordshire created national headlines after it sought to pay GPs to reduce their referrals and the GPC was forced to issue guidance to GPs telling htem to not take part in ‘clinically inappropriate schemes' to reduce referrals.

In minutes from its latest board meeting, this week, Bournemouth and Poole PCT reveals plans to restructure LES payment for GPs, to give greater financial rewards for those who effectively bring down referrals rates.

It says: ‘There is a significant contribution which GPs can make to achieve our recovery plan. Secondary care contracts are based on planned activity levels for the year and reports for the first six months of 2009-10 show a rising trend of over-activity in outpatient referrals.'

‘We also acknowledge that this overactivity is not only due to GP referrals, but also to referrals between hospital specialties, increased follow-up appointments and increased conversion rates. You may be re-assured that we are addressing all these factors. Nevertheless, GP referrals is an area in which significant reductions in secondary care usage can be made, provided we can work together to reduce variation between practices and maximise usage of community and primary care services.'

Anne Swan, the trust's director of acute and primary care commissioning, told Pulse: 'Referrals for urgent conditions, which include colon-rectal cancers, go through on our two-week fast track referral scheme. Processes for the fast track referrals have been completely unaffected by any changes made to referral management locally.

'The changes we have made to help GPs effectively manage their referrals have been designed with the input of GPs and practice based commissioning leads.

They aim to reduce referral variation and prevent referrals for treatments which are proven to be clinically ineffective, but will not have any impact on urgent referrals for suspected cancers.'

Cancer patients are being kep away from hospital to save money, it has been claimed Cancer patients are being kept away from hospital to save money, it has been claimed

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