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GPs having to refer urgent cases for hubs due to 'smart card' problems

Exclusive Extended access hubs are passing on hospital referrals - including urgent cancer referrals - to GP practices to process due to NHS smart cards not working in certain hubs.

Doctors working in extended access hubs around the country are unable to access online systems using their cards, which give staff secure and auditable access to e-referrals, meaning they cannot make referrals electronically.

NHS England acknowledged that some local community services cannot currently link to national digital systems, including the electronic prescription service, but stressed the problem was being looked into. 

At the moment some NHS trusts only accept electronic referrals, which means staff at the hubs are being forced to pass them onto nearby GP practices to process instead. 

In some cases, this has included urgent cancer referrals, according to GP leaders in south London who experienced the issue last year - and warned it had still not been resolved. 

They said the problems risk referrals being delayed, increasing the chance of errors by adding more steps into the clinical pathway, and also add to GP workload.

South-west London GP and professor of primary care at Imperial College London Professor Azeem Majeed said he became aware of the problem when his local hub sent urgent cancer referrals to his practice in Clapham. 

He said the local trusts would not accept referrals via any other route other than via e-referral - and that he raised the issue with his local CCG, but it had not been resolved.

However NHS Lambeth CCG said that while the problem was being dealt with nationally, it had secured agreement with local GPs and hospitals for practices to process referrals to secondary care, and was monitoring the system closely.

But Professor Majeed said: 'All NHS doctors should be able to make urgent cancer referrals and if a service can’t do this, it is not fit for purpose.'

Professor Majeed also pointed out that the referrals he received turned out not to be for his patients - and so had to be redirected again.

He said: 'We have been sent referrals for patients who are not registered with our practice and have had to return these to the hub so they can be forwarded to the correct practice, inevitably leading to a delay in the referral.'

Londonwide LMCs medical director Dr Elliott Singer said GPs working on hubs can still make referrals by logging into a separate system, EMIS Web, but pointed out it is a 'time-consuming' process.

He said: 'Our current advice is that in most cases GPs working in hubs should pass patients back to their registered GP to make an appointment and get a referral from them.

'This obviously involves some duplication and adds an extra element where human error can occur, in the form of the patient’s registered practice needing to receive and action the record of the consultation in the hub.

'Because of this risk of human error, we would suggest that in the case of two-week cancer referrals that GPs working in hubs do take the time to log into EMIS Web and make the referral themselves. We are not aware of any referrals being missed, two-week wait or otherwise, but it still feels safer to make these referrals directly.'

Professor Majeed said being able to make an urgent referral for cancer was an 'essential component' for any service and said he was disappointed this national problem had not been addressed by NHS England.

He said: 'It is a national issue. Many trusts won’t accept GP referrals that do not come via the electronic referral system (ERS).

'These referral forms are then sent to practices, which creates extra work for the practice as well as leading to delays in sending referrals.

'I would regard the ability to make two-week referrals for patients with suspected cancer as an essential component of any primary care or urgent care service and it is very disappointing that commissioners and NHS England have not found any solution to this problem.’

An NHS Lambeth CCG spokesperson said: 'The availability of ERS in the hubs, is a known national issue which the CCG and federation have developed a robust pathway in response to.

'In Lambeth, our pathway ensures that patients receive safe and effective care – including referrals – within required timescales.

'This pathway was agreed by all parties, including Lambeth practices and local acute hospital trusts, to avoid a parallel referral system which may cause delays.

'We monitor the pathway closely and the number of incidents or alerts raised for the service are very low. Each incident or alert is subject to a thorough review at regular contract and performance meetings to ensure patients receive safe and effective care.'

An NHS spokesperson said: 'Across the country extended access is helping patients get a local appointment with a GP, nurse or other healthcare professional in the evenings and weekends.

'Where local systems don’t yet provide access to all functions, patients still receive safe and effective care – including referrals - within required timescales.'

In Telford, GPs working in extended access hubs saw only 13 patients on Christmas Day, Pulse recently revealed.

Readers' comments (10)

  • Extended access just provide me with a list of tasks every morning for me to do, along with the list from the community nurses, Macmillan nurses, HF nurses, A&E doctors etc

    Just another lane on the smart motorway of NHS GP

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  • Azeem Majeed

    I first raised this issue one year ago. I note that NHS England have "stressed the problem was being looked into". It would be good if they came up with a solution rather than spending one year looking into the problem.

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  • The number of DNAs in our extended access is staggering.
    Whoever thought this up has not thought it through. Just like Smart motorways are anything but smart.

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  • Yep pretty much same in our Extended Access 50% to 100% no show when I do it.

    Sign into registered GP notes not the E A Hub for exactly the same reasons.

    Totally agree not fit for purpose, and suggest (old hat I know) solution is better 9-5 service and Emergency/OOH is for exactly that.

    Sad part is in 8 weeks time I'll be navigating this new improved NHS as user not a provider.

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  • NHS Smart cards; a bit like smart motorways. devised by a genius in a dark room with no contact with reality. Enforced by our world class NHS England, an organisation led by clowns.

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  • An embarrassing mess. Who is being demoted in NHS England for this?

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  • Bob Hodges

    Whereas if you have a 30,000 patient practice and you can be your own 'hub' and there's no data sharing shennanigans and the additional appointments are valuable extra capacity (including for QoF/Chronic Disease management). We also don't struggle to staff the hours either because we have 25 doctors and those that opt in start later in the day, and do one or 2 per month. Because we're seeing our own patients, the DNA is only 5% (still double our standard DNA rate though). Saturdays are paid as over time......and I'd rather see my own patients than work in OOH for less.

    However, I fully accept that what suits us is not a universal salve and that any attempts to force this model (that we have adopted for our own reasons) on others will fail utterly.

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  • Vinci Ho

    I think we all know that the IT system(s) in general practice (as well as in hospitals ) is not really up to the standard required to deliver all these ambitious objectives by the government .
    Now we are clear that the capacity to run the normal activities ( including two-week wait cancer referrals , of course ) is lagging behind . How often do you come across ‘ a problem with the EMIS system ‘ every week ? Not to mention about the slowing down of speed so often .
    The need for new investment in the IT system(s) is imminent.
    And that is another reason why private providers like the Babylonians are the ‘favourites’ because they were willing to provide the technology upfront , first , so as to win the contracts .
    Once again , the government and its health secretary(and the Chancellor of Exchequer as well ) have a decision to make of what direction to invest these so called ‘new fundings’ in NHS and general practice. If the fundamentals cannot be sorted , there is no common sense to talk about any further ambitious initiatives.

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  • Everyone should be able to refer patients on a 2ww really ??
    if I was being refered on 2ww into failing system, I would want a named, known,face responsible for it , do that when it or subsequent investigations stalled ihadsomeone I trusted to chase it up . it used to be called continuity and it workedr rather well . the more fingers you put in the pie the more the pie disintegrates.

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  • this mess has been caused by the ideological move to get rid of faxes and paper referrals when the e referral system has always been inadequate. To not have an agreed analogue back up system for urgent referrals when the move to e referrals only was implemented was stupid and clear safety issue. This work is now being picked up inappropriately by GPs. Simply madness! This issue can be solved in a day if there was any common sense! Allow faxed referrals till the e referral system is workable in circumstances such as these and stop over burdening GPs!

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