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GPs go forth

Remove referral decisions from GPs 'to avoid conflicts of interest'

NHS England has recommended the wider rollout of third party referral management to reduce the risk of GPs being accused of conflict of interest, in a move described by GP leaders as ‘especially perverse’.

The recommendation contained in guidance released by NHS England last month, recommends a ‘third party’ is used to manage referrals as part of a number of ‘good governance processes’ where GPs have an interest in a provider service that the patient could potentially choose.

The document, Managing conflicts of interests: Guidance for clinical commissioning groups, said in its recommendations to commissioners: 

‘There are a number of current good governance processes to ensure patients are being given appropriate choice, particularly where referring GPs have an interest in a provider service that the patient could potentially choose.’

It goes on to say: ‘Establishing referral management systems - There could be systems whereby, once a GP has made a decision to refer, a third party manages the discussion with the patient about which service they wish to be referred to. This would take away any perceived potential for GPs to influence patient behaviour.’

Dr Laurence Buckman, chair of GPC, said while GPs understood the use of referral management to save money, to recommend them to reduce conflicts of interest was a new suggestion.

He said: ‘The usual reason is that we want to save money, and that is honest. We accept that, even if we don’t like it. But to do so on the basis that we are conflicted, that seems to be especially perverse.’

Dr Chaand Nagpaul, a GPC negotiatior, said: ‘The Government’s guidance was suggesting that the decision about where a patient should refer to should not rest with GPs, but that a third party referral management centre should have that dialogue with patients to remove any conflicts of interest. This sort of suggestion is at odds with the doctor-patient relationship.’

But Ben Dyson, director of commissioning policy and primary care at NHS England, said: CCGs have a duty to manage any actual or perceived conflicts of interests. NHS England’s guidance on managing conflicts of interest suggests where GP practices are one of a number of providers to which patients can choose to be referred, CCGs may wish to consider systems that allow a third party to discuss with the patient which of these service they wish to be referred to.

‘This does not constitute a recommendation to roll out referral management centres. It is just one example of how CCGs could choose to manage conflicts of interest.’

Readers' comments (12)

  • If they are worried about conflict of interest, what about removing GPs from commissioning - something most grass root GPs dont want to do, don't get involved in and don't get paid for being (forced to be) involved in anyway!

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  • Hear Hear!

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  • I'm guessing would be another QANGO for all the managers who lost their jobs.

    I thought the reforms were to reduce the ridiculous levels of 'management' - not re-design them from one ugly manifestation into another....

    The bloated bureaucracy beast is fighting hard to stay alive...even at the expense of gratuitous insults on GP integrity.

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  • What is' insulting' is that these conflicts of interests were not transparent before - referrals have been made to failing organisations to keep up the numbers and save them from closure simply on the basis of personal relationships made through college/uni/medical school/even family members and groups with mutual interests. Referrals have been made which have given priority of access to the best available services at the soonest time to some individuals without any checks. It isn't a good solution not least because a person is forced to discuss their personal details with yet another health worker which for sure eroded the primary relationship.but in cases where this was not an open process anyway and one which disadvantaged some....what is the solution

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  • As someone with multiple medical problems why should I be subjected to even more pressure by forcing me to discuss referrals with an anonymous (I'm assuming the discussion would not be face-to-face) call centre operative.

    My GP has a full understanding of my medical problems and circumstances and between us we do a pretty good job of managing my health care.

    Someone above mentioned the possibility of adverse GP influence, could not a Third Party referrals manager working to an alogorithm do just as much, if not more, harm?

    And most people with multiple medical problems are only available to travel to hospitals within their local Trust anyway, and named-consultant referrals already seem to be a thing of the past.

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  • should read above:
    .... most people with multiple medical problems are only ABLE to travel to hospitals.....

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  • So let me get this straight. These reforms have resulted in the sacking of PCT staff, to be replaced by more expensive doctors, who in their turn are now effectively sacked from their day job by the conflict of interest their new role creates. You couldn't make this stuff up.

    If it didn't mean that we will all lose access to healthcare delivered by qualified professional, as opposed to monkeys with a checklist, it would be hilarious

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  • Nhsfatcat

    Third party referral management! Top idea. GPs see patient diagnoses problem sends person to third party for any further medical care or discussion /decision making/prescribing and so on.
    Each management step costing. Why not let the patient and Dr who have the records, knows them, their family, each other and just as important their local collegues well and having a great relationship with them can mean the patient sees the doctor that best suits them. It's not all about who can whack in the quickest cheapest hip joint; it's personality, trust, faith and compassion which may not be served by patient X seeing Dr Y because a faceless nobody in a referral management, unecessary step in the process says something different.
    As for accusations of old boys networks etc in the comments above, out dated they may be but the best question to ask of a Dr, ever, about a treamtent or referral is 'would you see this person?' Without local relationships the answer will become 'I have no idea,' especially when AQPs rule the world!

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  • Don't be daft....are they likely to say 'no I wouldn't personally see this person but it's ok for you'

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  • Drachula

    I am trying to set up a whole new pathway provision. I want the local GPs to have control over pathways and referrals in order to ensure quality, communications and cost. This referral management will undermine all the work that CCGs are attempting to do to save £2b this year. Come on NCB (or NHSE if you must), you are supposed to be there as light touch, not screwing it all up and making commissioning impossible!
    (These are my own views, and nothing to do with any organisations I work for/with)

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