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Inter-consultant referral crackdown to ramp up GP workload

By Nigel Praities

NHS managers are planning to cut hospital costs by toughening up restrictions on consultant-to-consultant referrals, Pulse can reveal.

The moves come on top of existing measures to prevent referrals between consultants and despite concerns that restrictions could pile extra workload on GPs.

A Pulse survey of 105 hospital trusts found 65% currently place restrictions on consultant-to-consultant referrals for conditions not related to the initial referral.

A third only allow consultant-to-consultant referrals for unrelated conditions in acute or emergency situations and 9% only for a list of certain conditions.

But the survey also revealed that many PCTs are planning to further drive down consultant-to-consultant referrals in this year's commissioning agreements with trusts.

The moves follow a report published earlier this year finding rising numbers of consultant-to-consultant referrals, which had increased from 16% to 21% of attendances since 2003.

NHS Heart of Birmingham said ‘sharp rises' in consultant-to-consultant referrals last year would be addressed by holding trusts to account.

‘This is being addressed through contract performance management,' a document published last month by the trust said.

North Central London Acute Commissioning – a coalition of five PCTs – also plans to refuse funding for consultant-to=consultant referrals unless they fit into an agreed protocol, with referrals between unconnected specialities a ‘particular concern'.

‘Onward referrals on a consultant-to-consultant basis can prolong and complicate a patient pathway when the GP may be able to manage the condition for which the referral was made,' the strategy document reads.

NHS Warrington and NHS Western Cheshire also said it plans schemes to reduce consultant-to-consultant referrals in acute trusts this year.

Restrictions on referrals between consultants have already provoked disquiet among GPs and have been cited as a possible reason for the increase in GP referrals, which increased by 11% in the third quarter of last year compared with the same period the previous year.

Dr Jonathan Fielden, chair of the BMA consultants' committee, said he was concerned as the majority of consultant-to-consultant referrals were justified.

‘The concern is that in more financially challenged areas, the knee-jerk will be that you can't refer between consultants and that will be detrimental to patient care.

‘Sometimes it is useful to reduce the number of consultant to consultant referrals, but in other areas they are absolutely necessary,' he said.

Dr Mike Parks, medical secretary at Kent LMC, said his local trust had recently sent a patient back to him to re-refer for a serious colorectal problem, after he had referred them to the urological department.

‘The difficulty is the pressure put on to reduce these referrals sometimes leads to appropriate referrals not taking place. The NHS is meant to be patient-centred, but in this case it is systems-centred,' he said.

Crackdown on consultant to consultant referrals

35% - of hospital trusts allow consultant-to-consultant referrals for conditions unrelated to the initial referral
30% - only allow these referrals in an emergency
9% - only allow these referrals for certain conditions

Source: Freedom of Information request from 105 hospital trusts

Clampdown: consultant to consultant referrals are in the firing line Clampdown: consultant to consultant referrals are in the firing line

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