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GPs asked to vet consultant referrals

Exclusive: GPs are being asked to scrutinise consultant-to-consultant (C2C) referrals as CCGs crack down on rising rates to cut spiralling costs.

NHS Oxfordshire has tasked GPs with challenging ‘any onward consultant referral they feel is inappropriate', via a new system through which practices will receive electronic copies of all non-emergency C2C referral letters relating to their patients.

Similar schemes are being operated at Newcastle upon Tyne University Hospitals NHS Trust, where consultants must make ‘direct communication' with GPs before a non-urgent C2C referral is made, and NHS Rotherham, where an audit showed GPs were unaware of 42% of C2C referrals. 

The moves come after a surge in non-GP referrals, with Department of Health figures showing a 9% year-on-year increase in the first quarter of 2012/13.

In a letter to the Oxfordshire LMC, Emma Torevell, the associate director of QIPP delivery at NHS Buckinghamshire and Oxfordshire PCT cluster, said the scheme would task GPs with closely scrutinising referrals in a bid to cut costs.

Ms Torevell wrote: ‘GPs need to be clear on the specific reason for onward referral, particularly given the apparently high level (and cost) of C2C activity in Oxfordshire. Having access to this information will enable those GPs who wish to, to challenge any onward consultant referral that they feel is inappropriate or could be managed differently.'

Dr Mary Keenan, medical director of Oxfordshire CCG, said: ‘Broadly, the consultants seem to be accepting.'

But Dr Paul Roblin, chief executive of Buckinghamshire and Oxfordshire LMC, said the proposals were a ‘big hassle' for GPs, and said the LMC would discuss alternative potential proposals this week: ‘There is a logic to putting constraint on the ability of secondary care clinicians to refer outside their sphere of confidence and to avoid waste. But it does put extra work on GPs.'

Dr Michael Dixon, chair of the NHS Alliance, said: ‘By far the faster expanding cause of referrals is C2C. In most cases, it is bona fide. But there are suspicions in some hospitals that this is fuelling an industry in payment by result tariffs.'

Dr Paul Flynn, deputy chair of the BMA's consultants committee and an obstetrics and gynaecology consultant on Abertawe Bro Morgannwg University's health board, said: ‘A lot of PCOs have got themselves worked up about this. But I would question evidence that [C2C] are any more inappropriate than referrals by primary care.'

Meanwhile, Coastal West Sussex CCG is asking GPs to challenge trust gaming after evidence suggested commissioners were paying double the correct amount for outpatient appointments. In its 2012/13 QIPP delivery plan, the CCG said there was ‘good evidence' that outpatient follow-up treatments were being charged as new outpatient appointments with the corresponding financial benefit to the trust. The CCG said closer GP monitoring of C2C referrals could help save £500,000 a year.


How GPs are vetting C2C referrals:

NHS Oxfordshire: All GPs must be sent electronic copies of C2C referral letters relevant to their patients

Newcastle upon Tyne University Hospitals Trust: Direct communication between consultants and GPs should be made in non-urgent situations, before referral is made

NHS Rotherham: All C2C referrals must be communicated to the GP

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