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Wednesday 23 May 2012
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BMA supports Pulse campaign

By Gareth Iacobucci | 22 Nov 2011

LMC leaders across London are pushing PCTs to sign up to a set of principles designed to preserve GPs' referral freedom, as national medical organisations throw their weight behind Pulse's A right to refer campaign.

Londonwide LMCs is promoting 10 principles for referral rationing, beginning with ‘it is a GP's professional responsibility to refer to or seek an opinion from a consultant or other clinician' and ‘a GP must be able to directly refer to secondary care when this is in a GP's opinion appropriate'.

It warned restrictions in referrals were coming alongside severe rationing of care, with more than 300 treatments added to ‘low clinical priority' lists across the capital in the last nine months.

The BMA and the Family Doctor Association have both leant their support to Pulse's campaign to preserve GPs' right to refer, alongside grassroots GPs across the country.

GPC chair Dr Laurence Buckman said: ‘Doctors are suspicious of imposition of referral management centres, seeing them as bureaucracy to cut costs rather than ensure patients get appropriate and timely care.'

'We therefore support the principles behind this campaign. We would always believe GPs should have the right to refer whenever they think it is in their patient's best interest.'

Dr Peter Swinyard, chair of the Family Doctor Association, said: ‘We should always be working in the best interests of the patient in front of us.'

'It is beneficial to have a retrospective review of referrals within practices and peer GP review, but blanket bans, caps and restrictions are bizarre, unethical and dangerous.'

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READERS' COMMENTS

Anonymous, Other healthcare professional,
23 Nov 2011
This is a slightly odd take on the issue of referrals. GPs will be able to continue to refer, as long as the cost of that referral is within the budget held by the GP's CCG. If the budget won't stretch then the referral can't be paid for so the referral will not happen.

This is the meaning of the passing of the budgetary responsibility from the DH down to the primary care level - the budget will be allocated and not negotiable, and if it is not enough to cover the costs of commissioning (for legal and technical support) and all referrals that the patients need on medical grounds, then some referrals will not be able to happen unless the patient can pay by some other means.

If the Bill passes, then "rights" granted by central government will be meaningless as the whole curative system will have been cut free of the public sector and deposited into the market. There is a set of diagrams here: http://pcwww.liv.ac.uk/~alexss/nhs.pdf , which explains the changes that the passage of the Bill will bring about.

If you do not want to see your ability to make NHS referrals shrink after this reform, it would be a very good idea to speak out now against the Health and Social Care Bill. What you are seeing now in terms of restriction of care is minor compared to the changes which will follow its passage. Afterward the primary care level will be utilised as a way of controlling overcharging in secondary and tertiary services, which will result from these being private hospitals, and ex-NHS hospitals which must compete against an expanded private sector for enough fees to keep them able to cover their costs with no government support. This is the managed care model (HMOs or ACOs), in which primary care services act to ration secondary care through a financial incentive to minimise referrals. Participation in this arrangment creates a serious conflict of interest which would be unacceptable to any GP who believes that their role is to assist patients who are ill to get appropriate care.

Don't expect to be able to fight it after the Bill has passed - if the idea that blocking referrals will improve your personal financial situation fills you with concern not joy, then you need to take action now.

The RCGP chair is fighting for GPs and patients on this - please join her if you care about your patients and your ethics: both are threatened by Lansley's reform.
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