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NHS drops plans for peer review of all GP referrals, says BMA

NHS England has seemingly rolled back on plans to introduce ‘peer review’ of all GP referrals following a backlash from the profession.

An update from the BMA’s GP Committee claims that NHS England has ‘changed its position’ in response to GPs' concern around the scheme, which would see GPs having to review their colleagues' referrals in a bid to cut costs of secondary care activity.

The GPC said that there are schemes in place, but these are 'resourced' and 'have been agreed with the local medical committee and practices'.

In August, Pulse revealed a leaked NHS England memo to CCGs pledging to give ‘significant additional funding to regional teams’ for interventions that could help cut referrals.

The memo specified 'internal peer review', which it claimed could cut referrals by 30%.

Pulse also revealed that CCGs were already implementing the schemes following instruction from NHS England regional teams, with a memo from NHS Bedfordshire CCG revealing that it had been asked ‘to ensure 100% coverage’ of the scheme in its practices. 

But this top-down direction caused outcry, with the GPC telling practices the reviews were ‘not contractual’ and asking NHS England to reconsider, and senior academic GPs raising concerns that it could lead to delays in patients receiving treatment.

Further pressure was heaped on NHS England when, last week, its own figures showed that the growth in GP referrals so far this year was already down 1.1%.

This compares with an 'expected long-term growth rate' of a 4-5% increase in non-GP referrals, with GP leaders blasting the NHS for 'focusing on the wrong target'.

An update today from BMA GP Committee chair Dr Richard Vautrey says NHS England will no longer expect clinical peer review to be mandatory.

In his letter to the profession, Dr Vautrey says: ‘NHS England has confirmed today that it has listened to our concerns and therefore changed its position. It has made it clear that it is not expecting clinical peer review to apply to all practice or referrals nor will these plans be mandatory for all CCGs.’

‘We are aware of a number of local schemes where the workload is resourced and they have been agreed with the local medical committee and practices.

‘Where developed in the future, GPC will continue to recommend local schemes should retrospectively reflect on the quality of referrals, be voluntary, properly resourced and take a supportive approach.’

Dr Arvind Madan, NHS England director of primary care said: 'We're happy to confirm that - as we have repeatedly made clear - there was never any intention to ask GPs to review every referral, and we have been working with the BMA and GP representatives to clarify guidance designed to tackle what are sometimes quite large practice pattern variations between individual practitioners and across geographies.'

Readers' comments (7)

  • I do not enjoy reading Pulse as I find it both depressing and demoralising BUT it does disseminate information in a timely fashion and always provides links (much appreciated) to allow exploration of the backstory to the headlines.

    If it were not for Pulse, are there any other similar offerings and what do others find a useful and timely source of reliable information?


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  • I concur that Pulse is a useful organ for information dissemination! NHS England is wise to row back on this expensive delay process to try and reduce Secondary Care referral. Hunt was not impressive at Conference. Workforce issues were weakly addressed.

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  • Someone has seen common sense over peer review of referrals! There are too may more important (and properly researched) things that need doing.

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  • This is extremely suspicious. Anything that smacks of good sense and reasonableness is just so out of character that there must be a sting in the tail...

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  • If all GP referrals must be peer reviewed I wonder what will happen in secondary care.
    I suggest that all junior staff decisions for CT or MRI or any blood test costing more than, say, £25 should be signed off by the consultant.
    In the case of consultants their decisions to operate, prescribe expensive drugs or order interventional radiology should also be signed off by another consultant.
    Each hospital will need to have a committee to oversee this with a support staff of at least 5 administrators with a minimum salary of £55,000 pa each.
    A director of transformation (£100,000 pa) will be needed to implement all this.
    Watch this space!

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  • Peer review because we can't afford nhs at point of delivery of services. gmc will not take that in to account. medical science is art unlike physics or maths . we make best decision based of what we know and learnt.
    good to know it is abandoned.

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  • Do you want to know a really good way to reduce referrals? Use the e-Referrals Advice and Guidance feature. Research suggests you'll probably be able to reduce your referrals hugely as a result.

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