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BMA calls for withdrawal of peer review scheme as GP referrals decline

Exclusive New peer review schemes are 'focusing on the wrong target', GP leaders have said, as official NHS data showed GP referrals to hospitals are actually in decline.

NHS England papers, published ahead of yesterday's board meeting, showed that GP referral growth reduced, by -1.1%, for the year to date (April-July) which is 'below the long term growth rate of 4.0- 5.0%'.

Meanwhile, NHS England figures published in August showed GP referrals decreased by around 0.5% in the year to July, compared with the previous year - while referrals from elsewhere increased.

This comes as advice issued by NHS England, recently unveiled by Pulse, said all CCGs should instate weekly GP peer reviews of referrals by September this year.

BMA GP Committee chair Dr Richard Vautrey said: ‘This is something we have been saying to NHS England and others in relation to the peer referral scheme. That it is a focus on the wrong target.

'GPs have been working hard to ensure that referrals to hospital are appropriate and they are not a source of a large rise in activity in hospitals.

‘These figures seem to confirm that. The pressures in hospital are for a variety of reasons, not least people living longer, becoming more frail and needing more care.’

NHS England is hoping that its peer review programme will reduce GP referrals by 30%, however this comes as a review into a similar scheme run by NHS Basildon and Brentwood CCG showed GP referrals rose by close to one fifth while it was in operation.

The review, carried out last November, led the CCG to drop the scheme but it has told Pulse it is now reinstating peer review based on NHS England's guidance.

A CCG spokesperson said: 'The review showed that while the scheme was in operation referrals from GPs rose by 17%. At an annual cost of £285,000 for the CCG, the CCG... decided to end the scheme.

But they added: ‘The CCG is on course to have a scheme in line with the NHS England guidance in place by the 1 October 2017.’

Essex LMC deputy chief executive Dr Andrew Bradshaw said the LMC was 'not consulted' on the scheme, adding: 'Any scheme devised and funded locally would still be voluntary. It should be clinically led by practices and not the subject of external imposition or diktat.'

Dr Alistair Lipp, medical director for NHS England Midlands and East 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.

'NHS England issued guidance on these nationally for CCGs and Basildon and Brentwood CCG have reinstated these reviews in line with this guidance.'

Nottinghamshire LMC said in a letter to GPs that they had called on NHS England to withdraw its advice, and also said practices should regard schemes as 'voluntary'.

Meanwhile, a pilot scheme for GP peer review in the North East of England saw GPs forced to seek approval for routine referrals from a team of GPs and GPSIs.


Readers' comments (7)

  • Locally here referrals as measured via the RMC are in decline but hospital outpatient activity is up owing to more 2ww referrals (not going to through RMC) because of the new NICE guidelines and more consultant-to-consultant and A&E generated internal referrals possibly due to hospital contract changes. It's just like squeezing a balloon in one place and it popping up in another part. Utterly missing the point.

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  • It has become accepted that it is very expensive for patients to be seen within secondary care. To solve this it would make sense to ask why this is so and seek to make changes within secondary care. However the issue is always thought to be due to the behaviour of primary care.
    General Practice used to be the most cost effective part of the NHS. For the past 10 years it has been starved of funds and is now rapidly collapsing.
    If GPs are forced to take part in these Peer Review meetings they will be adopting one of the expensive behaviours of secondary care that makes it so costly.
    It is exactly because GPs spend most of their working time consulting patients instead of attending peer review discussions and multi-disciplinary team meetings that General Practice is so cost effective.

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  • Der

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  • I am shocked the fall in referrals hasn't been investigated by NHSE as GPs are obviously under referring. This can only be solved by rigorous peer review. After all, this is about quality not money right? Right?

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  • National Hopeless Service

    Push me to peer review and I will simply increase my referral rate. Stupid question gets a stupid answer.

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  • A consultation - any consultation - is much like an investigation inasmuch as it has a false positive and false negative rate. Simple concept of sensitivity and specificity. But that seems to elude most politicians or medics who've crossed over. Anybody whose referrals are 100% "deserving" is either psychic or missing some others.
    Not by chance, is it named DoH!

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  • anon2016 @8.45am.... a bit confused. It is exactly that sensitivity and specificity that all peer review schemes are trying to support GP with. Surely that is in patients' and everyone's best interests. Are we honestly all so perfect that we do not need this support? I certainly do. How we do it is what we should be discussing, not whether we should. There is good evidence for effectively supported peer review, audit and embedding best practice. Binary referral demand management less so I accept when it is not done intelligently.

    A west country GP @10.50.... I get the balloon analogy but not that this is cause and effect necessarily. We all need to understand our role in optimising outcomes within finite resources. That inevitably means we need to try and support secondary care in being less active but not at the expense of primary care and specifically general practice without appropriate left shift. Difficult I know when we are so stretched and stressed, like many parts of the system. Only by working together with more trust and shared understanding and consensus will it improve. Lobby for more investment in the meantime by all means.... but.

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