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GPs struggle with backlog after most referrals were blocked for two months

Exclusive GPs in Liverpool were unable to refer for anything other than urgent cancer over April and May, leading to fears around a backlog of referrals in the coming months, the LMC has said.

Liverpool LMC has told Pulse that two major hospitals - the Royal Liverpool and Aintree University Hospitals – decided early on in the pandemic to only accept two-week wait referrals.

At one point, the option to refer was removed entirely from the directory of services on the e-Referral System, the LMC said.

NHS Liverpool CCG acknowledged there had been concerns raised by GPs, but added that the problems with the e-Referral system had been resolved, and there is greater collaboration between primary and secondary care.

However, the LMC said that there has been a significant knock-on effect due to a backlog of referrals.

At the beginning of the pandemic, NHS England had acknowledged that there would be reduced capacity in secondary care, but said that GPs should continue to refer.

In other areas of the UK, such as London and Birmingham, radiology referrals for suspected cancer in particular have been rejected, but the issue in Liverpool has covered all disease areas, including neurology and dermatology.

Dr Rob Barnett, secretary at Liverpool LMC, told Pulse: ‘The problems in Liverpool started early in the pandemic, in relation to Liverpool University Hospitals NHS Foundation Trust. [They] made a decision to only accept two-week wait referrals. They wanted GPs to hold onto these routine referrals, but it became obvious fairly quickly that GPs were struggling.

‘It was a ludicrous situation where GPs contacted consultants for advice via “advice and guidance” - the consultants had said the GPs needed referral, but during April and May, there was nowhere to make the referral.

‘Any type of referral was affected, such as for neurology, ophthalmology and dermatology. On the whole, two-week wait cancer referrals were okay, but there were problems for those needing endoscopies.’

He said that these problems have been alleviated. However, there were problems going forward, he added: ‘Our worry now is about the backlog of referrals, and another issue we're contending with is that patients are reluctant to go to hospital, even for surgery, for a fear of getting Covid-19.

‘I want patients to be seen according to clinical need, but worry that it’s taking a long time for them to be seen. The clinical needs in some cases are acute, with some GPs struggling to get patients seen appropriately.’

Dr Fiona Lemmens, chair of NHS Liverpool CCG, told Pulse: ‘Over the past few weeks, local GPs have raised a number of concerns through the LMC, related to difficulty in making routine referrals and pre-existing referrals being sent back to GPs.

‘As a result, the CCG has been liaising with the local NHS Hospital Trusts and GPs are now able to access services via the electronic referral system.

‘The North Mersey CCGs, LMCs and NHS Trusts have reconvened the previous Primary Secondary Care Interface meeting to bring together clinical colleagues to collaborate on recovery plans and communication between organisations.’

Dr Tristan Cope, medical director at Liverpool University Hospitals NHS Foundation Trust, said: ‘As with all hospitals across the country, we significantly re-focused our services to build acute and critical care capacity for seriously ill patients in the face of the biggest health emergency the NHS ever faced and we have continued to accept and undertake urgent activity, including cancer care during this period.’

In March, the month the UK was placed into lockdown and many NHS services began concentrating on Covid-19, GPs collectively made 30% fewer referrals.

Some of this is due to fewer patients coming forward - causing leading GPs such as Dr Nikki Kanani and Professor Martin Marshall to disseminate the ‘NHS is open’ message.

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Readers' comments (9)

  • Vinci Ho

    Thank you Rob and Fiona .
    NHSE needs to be fully conscious of what is actually happening in the frontline in different regions of the country .
    ‘Recovery’ is not exactly how they define and wish for .
    The barrier between primary and secondary care becomes ever worst .

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  • This is a bit of a national scandal
    NHS is not open and the covid situation has been used as an excuse to create new pathways and barriers to patients getting secondary care all in the name of balancing budgets
    with the new strategic partnerships CCGs are losing any influence they had and 2ry care is calling the shots. They have been given block contracts based on last years activity and are creating all sorts of barriers to access out patients, daignostics and elecive procedures. They are on a real go slow in terms of opening up.
    I think LMCs (at least ours) have had a poor handle on this and not really working well for GPs. They need to alert the public on what is happpening- 2ry care is closing down!

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  • is pulse going to survey what has not re opened once lockdown has settled - like ent services, family planning, podiatry, sexual health etc? already happening but covid will make it worse

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  • To non-primary care providers

    Why aren't you care opening yet? Locally we have a handful of specialties that will accept referrals and these only opened this week - including radiology. I look at my patient list every surgery and the reasons for consulting and am left dismayed that I will be having the same conversation with patients multiple times about how I can't refer them for the care they need. It is demoralising and at times this whole process is feeling pointless.

    Other sectors in society have opened up in rapidly when the green light was given - why is the NHS so slow? You have had months to prepare so why aren't you ready?

    I suppose there are commercial drivers for shops and businesses to open and the cynical side of me feels that this has been an opportunity to clear waiting lists by discharging patients and not accepting new referrals with no financial penalties. Added to that is the writing off of trust debt.

    We have reset now and it is time to open up again. We need to be able to refer again. How those patients are managed should be up to you - we have had to make significant changes to the way we work and so will you. We can't keep all these patients, and all the consequent risk, in primary care indefinitely.

    Our patients need your support to manage their conditions because on our own we can't do this.

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  • At the daily briefing, why didn't Kanani just say...'go see your GP, hurry up, but they can't do much for you - instead risk their licence and own health...just go, go!'. And send a nanny state text reminder too.

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  • Everyone to A&E --- simple

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  • I can't understand what the problem is :- if your consultant blocked a reasonable referal without good reason, report them to the GMC!

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  • There are dangerous new developments even as particular sections of the NHS re-open. In my area every "education session" Consultants are unilaterally changing the parameters. We are being instructed about new "virtual clinics" or as I call them "Advice and Guidance on Steroids" basically no more conventional OPD but GPs being instructed to perform long lists of investigations pre and post "Virtual Clinic". Congratulations guys! Time to revisit being a House Officer again!

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