This site is intended for health professionals only
Wednesday 23 May 2012
Facebook Twiter Linkedin

GP referral cuts a 'catastrophe' for hospital finances

By Gareth Iacobucci | 28 Sep 2011

Exclusive Hospitals are suffering a ‘catastrophic' loss of funding because of plunging rates of GP referrals as NHS managers block access to services, Britain's most senior consultant has told Pulse.

Dr Mark Porter, chair of the BMA consultants committee, said the fall in referrals coupled with other factors such as tariff restrictions was forcing hospitals to consider mergers or cut access to ‘whole parcels of services'.

His comments came as the Foundation Trust Network, which represents hospital managers, pledged to investigate the effect the sharp fall in GP referrals in the first quarter of this financial year was having on secondary care finances.

GP referrals dropped by an average of 4% in the last quarter compared with the same period the previous year, with falls of up to 37% in areas with controversial schemes to restrict referrals.

Dr Porter said: ‘This is proving a catastrophe. I know of hospitals coming off the FT pipeline, hospitals being forced to consider merging, hospitals being forced to restrict whole parcels of services, and many of the reductions in referrals are to do with the low-priority procedure lists.

‘Some of the reconfigurations will be appropriate. But it's impossible to know which are appropriate and which are prompted by inappropriate resource restrictions.'

A snapshot Pulse survey of clinical commissioning group leaders found most expected hospital finances in their area to be hit by reductions in referrals, and seven out of 10 believing closures or reductions in capacity would follow.

Dr Amit Bhargava, GP in Crawley, West Sussex and chair of Horsham, Crawley and Mid Sussex CCG, said:  ‘We're trying to reduce demand and that does have an impact on our local hospital - though that is welcome at the moment as they are having difficulty coping with the numbers of patients in both planned and unscheduled care.'

Dr John Ribchester, a GP in Whitstable, and chair of the Whitstable Practice CGG, said:  ‘It is likely there will be closure of outreach outpatient departments in community hospitals.'

The Department of Health hailed the drop in referrals – the first in six years - as evidence the NHS is ‘working more effectively and more efficiently'.

But a spokeswoman for the Foundation Trust Network said it would investigate the effect on its members' finances: ‘We don't have any evidence on how it could be affecting providers, but we are planning to look at this area in the near future.'
 

READERS' COMMENTS

Anonymous, PCT,
28 Sep 2011
The drop in referrals is just part of the problem for Acutes. The choice agenda along with various PCT projects has opened up capacity in the private and community sectors. The only way Provider/Commissioner 'works' is if providers exit the market, otherwise their isn't enough money to go around.

Our Acutes are under pressure from a mix of poor quality/efficiency and cherry picking. You either go with this line and hospital finances force them to close wards/entire hospitals or you follow Dr Gerada who wants Acutes to be protected. I believe that the current system allows financial difficulties to override clinical need and therefore should be 'abolished'. We need instead to invest in the NHS and manage it properly.

PCT Finance Manager
Average (1Vote)
Top
Vinci Ho, GP Partner,
28 Sep 2011
GPs are in a very passive position. High referral rate has become a stigma . You are not only likely to be penalised financially but also named and shamed as being compared to your neighbouring colleagues . Hence , you are labelled as cr*p practice . So much about putting patient's care first. I accept that GPs can hold on the patients with some chronic conditions longer and refer untIl the last minute. This then will have the negative effect on the finance of NHS trust providers under the current tariff system.
Next level is transferring services out into community .Then the bidding war starts . Competition is no longer about better quality but about ,'Can you make it even cheaper?' Private provider can perhaps sustain a loss for while but NHS provider cannot last long . Yes , there is then a risk of closure and throwing towels . Once again , the tariff system needs to be sorted out.
Relationship between GPs and secondary care can only go worse under such holding back referrals and cage fighting amongst providers . Integrated care? Forget about that............
Average (1Vote)
Top
Anonymous, Practice Manager,
29 Sep 2011
Welcome to the real world. Over-trading and 'gaming' on the tariffs has been a nice little earner for hospitals who have used the excess funds to pander to their consultants' wishes. Hospitals remain instrinically inefficient (Gerry Robinson); hospitals should be run for the benefit of patients and not consultants. Managers must focus on the inefficiencies & drive improvements to show that they can operate in the real world.
Average (2Votes)
Top
Anonymous, Other healthcare professional,
29 Sep 2011
I'm sorry but isn't this exactly the idea behind the reforms. There would be no point in GP's reducing their referrals unless that resulted in reduced acute spending. (Ignoring the fact that beds would become available for non elective cases at a higher cost and consultants time would be released from low value OP clinics to facilitate high value IP sessions, of course)

Bearing in mind the reforms have stated that a consultant from a neighbouring acute trust should be on the Senate of CCGs - exactly the people who would benefit from the failure of the local acute trust - then this seems the stated direction of travel the coalition want to take with the reforms.

If you were extremely cycnical you would say it's only purpose is to use GPs as the tool to free up beds, that were previously available to the population as a whole, to be used as private beds in foundation trusts - as the only possible way forward to assure acute trust survival. Let's see what the result of viability reports on Acute trusts currently being undertaken by management consultants is shall we?
Average (0Votes)
Top
Anonymous, PCT,
29 Sep 2011
Some good points being made here. The only issue with getting Acutes to become more efficient is that under Choice the patients aren't there any more. We risk in the short term that desperate Acutes will try and devise ways of getting more patients admitted.

The long term? is it getting more private patients as anon HP suggests or closure? Ideally, it is patient satisfaction, effieciency et al dragging back patients to the good old NHS and forcing the private sector to go back to insurance work. Yes, I can hear you laughing already but it is amazing what a bit of planning and investment will do.

PCT Finance Manager
Average (0Votes)
Top

ADD YOUR COMMENTS

Please note You must be a registered user of PulseToday and logged in to add comments. Opinions expressed below are those of the writers and do not necessarily reflect those of PulseToday. Comments are considered in the public domain and may be used in future Pulse coverage. We accept no responsibility, legal or otherwise, for the accuracy or the content of member comments.

Comment*

You must be logged in to add a comment.Clickhere to login.

SIGN UP FOR EMAIL NEWSLETTERS

Keep up-to-date with the latest changes to the NHS, CPD and clinical guidelines. Sign up below or find out more.

POLL

Is self-care the answer to the NHS efficiency drive? Read the full story here