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GPs attack ‘unsafe’ bounce-back of referrals over pro forma errors

Exclusive NHS managers are blocking GP referrals that are not made on time-consuming pro forma, in a move GPs warn is driving up workload and risking patient safety.

GPs in London are having referrals blocked until PCTs receive pro formas GPs claim take 20 minutes to complete, while Wessex and South Staffordshire LMCs have both warned providers of the dangers of rejecting standard referral letters.

NHS North West London, which covers eight PCTs, insists GPs complete a pro forma ‘so referrals can proceed' under its Planned Procedure with a Threshold policy.

Local GPs told Pulse they had had referrals blocked for treatments such as knee arthroscopies if they had not completed the time-consuming pro forma.

Dr Andrew Lees, a GP in Ealing, said: ‘If I refer without the form the hospitals will reject my referral and the patient will be sent back. The decision to refer should be made between a GP and a patient – this form contravenes that.'

An NHS North West London spokesperson said:

‘Referrals are not rejected, but the tick box forms were developed in order to facilitate and support clinicians in determining whether patients meet criteria thresholds. [However] we do ask that GPs complete the forms, as have been agreed, so that the referrals can proceed.'

South Staffordshire LMC's December newsletter says it has written to local GP commissioners and the PCT about the issue, warning: ‘It is unsafe for providers to reject referrals on the grounds pro-formas have not been filled in correctly. Clinicians in the provider service could find themselves liable for any harm that befell a patient as a result of any rejection of the referral.'

Dr Nigel Watson, chief executive of Wessex LMCs, said: ‘Proformas can be helpful in certain cases, but they are not a statutory requirement, and referrals should not be bounced back. It is a significant issue. Each time we've had it with providers we have told them that if you reject referrals on this basis and harm comes to the patient then you will be held responsible.'

Dr Paul Golik, medical director at North Staffordshire LMC, said: ‘We do have an issue with occasional referrals being rejected because the "incorrect" proforma has been used and do support the statement made by South Staffs LMC.'

'Secondary care providers need to ensure that patients needs come first rather than adherence to petty bureaucracy.'

Birmingham LMC and Manchester LMC told Pulse that GPs were being swamped by workload as providers were issuing growing numbers of referral templates for GPs to complete.

Dr Peter Holden, a GPC negotiator and a GP in Matlock, Derbyshire, said: ‘GPs have the right to issue referral letters. It is not for hospitals to refuse referrals on bureaucratic grounds. A referral is what it says it is. They should not be rejected because they are the wrong piece of paper.'

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