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The waiting game

GPs forced to get approval before referring patients to hospital

GPs are being forced to wait for specialist advice before referring patients to hospital under a new pilot programme in the North East of England.

The Clinical Assessment and Peer Review (CASPeR) system, which is being rolled out across Darlington, Stockton-on-Tees and Hartlepool this month, aims to reduce 'variations' in patient assessment and care as well as ease the 'considerable pressure on local hospitals'.

GPs will have to wait up to two days before receiving an answer in some cases.

NHS Darlington CCG and NHS Hartlepool and Stockton-on-Tees CCG said that they ‘recognise the importance of delivering high-quality care to patients’ but added that 'they have to do this using NHS resources wisely'.

But local GPs said this was simply a 'very expensive paper exercise'. 

Under the scheme, a team of GPs and GPSIs will 'assess routine referrals from GPs within two days' and will offer advice to 'go ahead in the usual way or consider alternative treatments or tests first'. Urgent referrals will not be affected.

GPs will be able to appeal decisions in cases where the referral has been rejected.

A spokesperson said: 'The new system should support GPs with a specialist opinion on management of a patient and will help to ensure that they are treated in the most appropriate way first time based on best practice guidelines.'

But Professor Ahmet Fuat, a Darlington GP and professor of primary care cardiology at Durham University, warned that this will have little benefit while increasing GPs' workload.

He said: 'The evaluation team will only have a referral template and definitely no access to clinical systems or notes. I cannot see how a GP without specialist knowledge or access to notes will be able to give advice to a GP not to refer, or be able to redirect referrals appropriately in anything but a handful of cases.

'I just don't agree that this anything more than a very expensive paper exercise, which is very unlikely to cut referrals or be cost effective, and will have a huge impact on workload for our already overstretched and stressed secretarial staff.'

Another local GP, who did not wish to be named, was able to 'say with certainty' that there are 'a lot' of Darlington GPs who are 'very unhappy with what we are being asked to do with CASPeR'.

The GP said: 'By far the biggest problem we currently have in Darlington is a serious and extremely worrying lack of GPs, with no solution in sight, and a situation that is likely to get worse.

'The recruitment of local GPs to help manage CASPeR can surely only be at the expense of our already overstretched workforce and may well make it more difficult to attract GPs to Darlington.'

This latest pilot follows a 2012 study, published in British Journal of General Practice, revealing that referral management schemes do not reduce the number of patient referrals and can be expensive.

But the spokesperson for the CCGs said: 'CASPeR is based around similar systems which have already started in other parts of the North East, which have shown to be of benefit. We believe the cost of the system to be an effective financial model given the increased quality of care the service will deliver for patients.'

It comes as grassroots GPs have instructed the GPC to launch a ‘national debate’ with Government and health bosses on what care the NHS should stop funding, while vast numbers of CCGs ration treatments such as IVF, and as NHS England is looking at what over-the-counter and 'low-value' items it can ban GPs from prescribing.

Readers' comments (34)

  • Just Your Average Joe

    Very simple solution to this problem.

    Under NHS Charter all patients have the right to request a specialist opinion - no Complaints team ever rejects a patient complaint based on the failure of this to occur no matter how inappropriate.

    Ie want a tertiary hospital referral for self limiting condition - as on choose and book - no choice but to refer, and no support from NHS England, when try and manage locally or in secondary care for initial opinion.

    All referrals are: Dear Colleague - my patient has requested a specialist opinion for XXXXX

    Kind Regards

    If they turn them back they can handle the complaints which NHS England always respond back with go ahead and refer.

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  • Do not forget, it generates income for GPs who find it hard to see patients face to face. or I would say easy money.

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  • Dear All,
    GPs have a duty to refer when they feel it necessary. They should continue to do so. I'd like to know if the GPs who will be vetting the referrals have told their indemnity organisation about this new role.
    Paul C

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  • When I started 23 years ago I had 3 partners and 7000 patients , with 4 practices in my part of town. We offered a good service and considered referrals before making one. Today I have 3 partners and 16970 patients, with paramedic/nurse/ salaried support, and am one of 2 practices. Referring is often the only option in the absence of routine appointments. The possibility of Introducing this makes me wonder how my practice would cope with 3 partners not 4 .

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