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Consultant-to-consultant referrals ban piles pressure on GP practices and delays treatment

Exclusive Practices are being put under increased pressure as CCGs block hospital consultants from referring internally for non-urgent conditions and send patients back to their GP to save money.

Pulse has learnt that a number of policies drawn up this year by CCGs have banned non-urgent consultant-to-consultant referrals at trusts to tackle rising numbers of consultant-to-consultant referrals and help CCGs achieve their QIPP savings target for 2013/14.

But local GPs have criticised the policies, saying they lead to more work for GPs, and have led to cases that should have been seen urgently slipping through and having treatment delayed.

Basildon and Brentwood CCG has introduced a new QIPP policy this year which says hospital consultants should routinely send patients back to their GP to make the decision regarding an onward referral for all conditions, other than urgent referrals for conditions such as suspected cancer.

The policy was designed after a 44% increase in consultant-to-consultant referrals since last year. A spokesperson for the CCG said the policy would ‘ensure that people are cared for in the most appropriate setting’, and ‘demonstrate value for money for taxpayers’.

A similar scheme was introduced by Ipswich and East Suffolk CCG this year. The scheme allows for consultants to refer patients to other consultants for treatment related to their original condition, or for an urgent condition, but all other patients requiring non-urgent treatment should be ‘advised to book an appointment with their GP’, the guidance said.

In Berkshire, Buckinghamshire and Oxfordshire all non-urgent consultant-to-consultant referrals are routinely returned to the patient’s GP, except for those for paediatrics, oncology, radiology, emergencies or cancer. A CCG spokesperson said that the guidance had led to patients treated in the right clinic by the right consultant and had cut costs. They added that initial analysis showed that ‘more appropriate consultant-to-consultant referrals are being made’.

But Dr Paul Roblin, chief executive of Berkshire, Buckinghamshire and Oxfordshire LMC, said that consultants were ignoring the guidance and expecting GPs to do all of the referrals, even those categorised as urgent.

He said: ‘Hospitals aren’t following the guidelines. They’re referring stuff they should be doing themselves. In many cases the consultants are referring back to the GP when the referral falls into one of the categories above. When it crops up it causes a big furore. I probably get a letter about it once a month.’

Dr Brian Balmer, chief executive of north and south Essex LMC said that the new system was ‘bureaucratic’ and meant patients and GPs were left to pick up the pieces.

He said: ‘This is creating an increased workload for GPs. They’re already bursting at the seams and this is piling on more work. It makes us look inefficient. It gives the patient a lot of hassle. The  whole system, it’s a market from hell.’

Dr Fayez Ayache, a GP partner in Ipswich said patients that should have been referred on by the consultant urgently are being sent back to the GP, in a practice she calls ‘scary’.

She said: ‘For good care you need to shorten the pathway. The responsibility for the GP to make the referrals makes that pathway longer, it’s filled with management delays. It’s a lot of extra work for the GP and the patient themselves.

She added: ‘The majority of referrals we get could be read as urgent - we could miss or delay an urgent care. It’s scary.’

The news comes after Pulse reported last year that GPs were being asked to vet consultant referrals as CCGs tried to balance their books.

Readers' comments (12)

  • This is a ridiculous situation. Historically a small proportion of these WERE inappropriate (Ortho Consultant refers to Gynae for them to start a patient on the Pill etc - yes this actually happened) but the vast majority are quite appropriate. Essentially GPs are being used as an unfunded triage service. We might stop the odd referral and save a few pounds, but of course no-one considers our time and staff costs whilst we are doing this. Obviously GP time is free and infinitely elastic...

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  • Vinci Ho

    Think about it:
    Our (GP's) referrals are being vetted by referral management (RM) and consultants' referrals being vetted by us( which in reality can be vetted further by RM)
    Seriously? What kind stupid culture have they created? Value for money? REALLY??
    The bottom line is they want to only allow 'fixed' ,lower amount of referrals to go through every month because of money . Of course , the bureaucrats and politicians have no guts to say that to the public.

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  • "a 44% increase in consultant-to-consultant referrals since last year" is a huge increase. Did anyone think to look in to why such an increase occured?

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  • I get the increasing feeling that CCG see GPs as nothing more than a free or cheap alternative to secondary care.

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  • Blame the internal market

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  • Any referral should always be done by the doctor wanting an opinion from another doctor with a letter explaining what the referring doctor wants from the doctor he is referring to.
    Anything else is bad medicine.
    Always was; always will be.

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  • Another scenario is when a hospital doctor, sometimes a consultant sends a patient back to GP telling the patient to ask for a referral to another consultant when this is patently not necessary. This is sometimes backed up by a letter but not always with reasons.
    If the referral is not complied with the patient is left worried however the correct the decision is.

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  • The 44% increase is meaningless, especially if the number of referrals the previous year was only a small number ie. 50, then the increase was only 22 referrals.
    I wish bureaucrats would use collected data correctly by stating a ballpark figure then stating the the percentage increase.

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  • Given that CCG's are now GP led organisations one can only assume that those GP's leading CCG's think this is a good idea and have dicussed it with colleagues and understand the evidence to support that decision. If not then whats the point of a CCG?

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  • I agree with Colin Spencer. Just had a rheumatologist suggest a referral to dermatology for a small patch of eczema. He obviously doesn't know we are capable of dealing with eczema, especially with my post grad dip in dermatology.

    The other one is "i've replaced the left knee now but can you refer the patient back to me for right knee replacement". Apparently you are only allowed to see to the side GP referred and need a new referral for the other side......

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