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Independents' Day

GPs to be asked to 'peer review' all referrals

Exclusive CCGs are formulating plans to scrutinise practices' referral systems after a leaked NHS England memo showed they have promised to incentivise peer review schemes in order to reduce referrals by 30%, Pulse has learnt.

Pulse has learnt that NHS England wrote to CCGs in May, asking them to ensure that there is ‘clinical peer review of all referrals from general practice by September 2017’, and this should be done on a weekly basis.

The May 2017 guidance ‘Elective Care High Impact Interventions: Clinical Peer Review’ says that there will be 'significant additional funding' for commissioners to establish GP peer review schemes this year.

Pulse has seen an email from NHS Bedfordshire CCG to commissioners on plans to scrutinise GPs' referral schemes.

It states: 'As you will be aware there is now an ask from NHS England for us to ensure we have 100% coverage of prospective peer review in practices. The attached document sets this out. [The local area team] needs assurance from that we have a plan to do this and how that will be rolled out across practices.'

The email includes an attachment from NHS England on plans to incentivise these peer review schemes.

The NHS England report says: 'Significant additional funding is being given to regional teams in 2017/18 to roll out and spread interventions and schemes that will help CCGs to deliver a slower growth in referrals.'

It states that good practice would be for GPs to review each other’s new referrals, at least once a week, to ensure that ‘all options are explored and that patients are seen and treated in the right place, at the right time and as quickly as possible.’

But the guidance also makes clear that that the process ‘should not be established as an approval process’ and the ‘referring GP retains responsibility for the patient and makes the final decision’

This comes after Pulse recently reported on a pilot scheme in the North East of England, under which GPs must get approval for routine referrals from a team of GPs and GPSIs.

NHS England claim that ‘published literature identifies internal peer review as a positive intervention with benefits to patients and GPs and it could also reduce referral rates by up to 30%’.

But Professor Azeem Majeed, professor of primary care and head of the department of primary care and public health at Imperial College London, warned that referral management schemes can sometimes ‘result in delays in referrals’, particularly when assessors are ‘not fully aware of the background to the referral’.

He said: ‘To carry out effectively, clinical peer review requires adequate time and resources.

‘Given the current pressures on NHS general practice in England, this scheme may well end up as a tick-box exercise rather than something that will improve patient outcomes and NHS efficiency.'

GPC clinical lead Dr Andrew Green said: 'I wish NHS England put a tenth of the effort they expend on reducing pressure on hospitals into reducing pressure on GPs, which is the area of the health service with the biggest growth in workload.

'We are used to seeing un-referenced claims such as "could reduce by up to" in adverts for antiwrinkle cream and I am surprised to see such language in an official document.

'It is important to be aware of the lost-opportunity costs of schemes like this, if we assume an hourly weekly meeting that would be equivalent to removing 1000 GPs from the English workforce, GPs we don’t have.'

An NHS England spokesperson said: "Clinical peer reviews are a simple way for GPs to support each other and help patients get the best care, from the right person, at the right time without having to make unnecessary trips to hospital. More than half of CCGs have already implemented some of peer review system, with Luton seeing an 8% drop in hospital referrals, and the latest NHS England guidance will help ensure best practice is shared to remaining local commissioners."

A spokesperson at NHS Bedfordshire CCG said: ‘The executive team at NHS Bedfordshire CCG is currently in discussion with clinical leads on the implementation of the Clinical Peer Review system.

‘Details of the agreed system will be advised in due course.’


Readers' comments (31)

  • The extra stress these schemes inflict on GPs will help push a few more into premature retirement.

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  • The only way this will reduce the number of referals down is by decreasing the number of GPs down by 30%.It wont do it then.Bunch of puppets NHSE.

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  • More time buggering about not seeing patients

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  • So who's indemnity pays for the missed cancer Dx???

    I say this from personal experience of lesion on leg. GP and Consultant Dermatologist Dx initially as pyogenic granuloma, patient refused any treatment under LA, went on usual low value funding trip as wanted treatment under GA. 3 months later approved, referred to Plastics who advised possible amelanotic melanoma.

    When pointed out this nonsense to NHS E they said all my fault and I should have sent as 2WW in first place!

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  • what if we already do this are we going to get extra extra funding for doing this !"!

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  • "...should not be established as an approval process’ and the ‘referring GP retains responsibility for the patient and makes the final decision"
    Well in that case, my original referral decision will stand.
    But round here the central referral service is most definitely an approval process and no option but to follow 'advice'
    Must check whose indemnity is responsible.

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  • They consider GP time to be - 1 limitless and - 2 free. I do remember when they priced the OOH responsibility and took it over , within 3 months they discovered it was going to cost X 3 their original estimate. Roll on the end game

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  • Why pretend GPs are valued specialists in primary care ? it is not necessary to put in such draconian time wasting measures Referral rates for individual GPS and department specific data must be already available for referrals and it would seem any apparently over referrers could be found and helped from this General practice is about patient care and is stretched to the limit already It is no wonder that it is unattractive to new doctors a it becomes more and more task orientated and undervalued Things will not improve with the massive import of doctors from abroad who will have the basic medical knowledge but lack the understanding of the patients in their setting It is always good practice to discuss difficult cases and a majority of GPs do this

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  • I have spent years at meetings where we 'split into groups' and took turns at discussing our referrals in different specialities. It was a bit 'my name is ... and in the last 3 months I have made ... dermatology referrals' - as if it was a crime/sin. My referral practice did not change as a result and I am sure nobody else's did either. It was a total waste of time.
    We now use a referral management system - at least the triagers here are either specialists or GPSIs. I object to fellow GPs who may know less than me deciding what happens to my patients. I am perfectly happy to take advice from anyone who knows more than me.

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  • Vinci Ho

    I look at this in a slightly different angle . The tone of the NHSE is different from before the general election : demonstrated how 'feeble' and pathetic is this zombie government led by a JAM prime minister . The situations and outcomes in current Brexit negotiation with EU and the transparency ,representation of workers in boardroom of big private businesses , told the story and possibly the fate of the government .The opposition(s) are moving and making promises for another general election. Was not surprised Harriet Harman was trying to demand GPs to take on stupid but politically correct job(s) for the public .
    Politicians will be fighting for credibility as this is a minority government losing steam . Important point for those representing us to realise , especially on negotiation table .....

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