Hospitals demand GPs write consultant-to-consultant referral letters
By Gareth Iacobucci
Hospitals are introducing measures requiring GPs to write referral letters for transfers from one consultant to another, prompting concerns that managers are exploiting the Payment by Results system.
Almost half of hospital trusts are now sending consultant-to-consultant outpatient referrals back to GPs, in many cases after recent changes to policy.
The move allows hospitals to claim additional payment by counting such referrals as new episodes of care. But it also increases the bureaucratic burden on GPs and demands they write letters on cases with which they may not be familiar.
A Pulse investigation found as many as 45% of trusts were now sending patients requiring an additional hospital service back to the GP for onward referral. About 60% of these trusts had introduced their current policy in the past two years.
Some trusts insisted changes had been requested by PCTs in order to move services back into the community via practice-based commissioning.
A few others had recently ended requirements for GPs to write referral letters to avoid unnecessary workload for GPs.
But trusts overall were increasing their requirements on practices, prompting criticism and warnings that many trusts could be gaming.
Dr Andrew Green, a GP in Hull, said he was ‘confident' hospital trusts were gaming figures. ‘More and more, we're getting cases where consultants refer back to a GP, sometimes within their own specialty.
‘It's purely trying to cut down on activity within the hospital – it has to be to generate new income. I can think of no other reason.'
Dr Michael Barrie, a GP in Kingston upon Thames, Surrey, where the trust has recently started referring patients back to GPs, described the process as ‘a pain in the neck'.
‘It's a tick-box duty, and the GP has to carry the can. I'd like to see a seamless service from GPs to hospital, with patients staying within secondary care.'
But Dr Jeremy Harris, a GP in Kingston and chair of Kingston & Richmond LMC, said it was right referrals should be passed back to GPs as part of practice-based commissioning.
He said: ‘It gives me the opportunity to deal with it myself if I have the expertise, or to refer where the patient wants to go.'Hospitals: accused of gaming over referrals Hospitals: accused of gaming over referrals