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GP referrals 'surge' may be PCTs counting patients twice

By Steve Nowottny

Exclusive: The steep rise in GP referrals that has so panicked PCTs and placed practices under severe pressure may largely have been the result of IT systems counting patients twice, NHS managers are admitting.

Trusts across the country are investigating whether use of Choose and Book, and the double-counting of referral records, may be at the root of what has appeared a dramatic increase.

Managers in one trust blamed duplication arising from ‘system changes' for more than half its increase in referrals, with the suspicion that Government waiting targets have driven some trusts to gaming of the booking system.

The news that managers are finally admitting that the apparent rise in referrals could be a false alarm came as Pulse obtained a BMA document also reaching a similar conclusion.

The document offers a range of explanations for the rise, including coding problems with Payment by Results, the 18-week referral-to-treatment target and increasing number of requests for GPs to re-refer patients.

Recent figures have shown year-on-year rises in GP referrals of more than 10% over four successive quarters – a trend that has puzzled health experts but has resulted in pressure and criticism being heaped on GPs.

But a report to the board of NHS Cornwall and Isles of Scilly in April stated: ‘GP referrals are above plan by 9%. It is estimated over half of this relates to duplicate records arising from system changes such as 18 weeks and Choose and Book.'

A separate report to the PCT's professional executive committee also advised of ‘significant' duplication, which a spokesperson insisted had since been resolved.

Elsewhere, NHS Derby City said its total GP referrals had jumped by 10% last year, but the number of referrals seen in hospital had only risen by 6%.

A spokesperson said: ‘We have been checking referral datasets and querying duplication of referrals. It has now been acknowledged that processes need to be revised to ensure duplications are not reported.'

NHS Brighton and Hove City, NHS Medway and NHS Hull all also said they were investigating duplicate referrals as a possible cause of the rise.

GPC deputy chair Dr Richard Vautrey said PCTs should be concentrating on resolving duplication and other procedural issues rather than clamping down on GPs' freedom to refer: ‘They need to be focusing on the perverse incentives developing within the system. I don't think it's a genuine rise.'

Dr Richard Vautrey, GPC deputy chairDr Richard Vautrey, GPC deputy chair Dr Richard Vautrey

PCTs must focus on the perverse incentives now developing in the system

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