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Consultant chair steps down and warns GP referral cuts put patient safety at risk

By Gareth Iacobucci | 13 Dec 2011

A senior hospital consultant in an area spearheading GP commissioning has resigned from his position representing secondary care doctors and claimed restrictions on GP referrals and caps on activity were putting patient safety at risk.

Guy Broome, an orthopaedic surgeon who chaired the medical staff committee at debt-ridden North Cumbria University Hospitals NHS Trust, said he was no longer prepared to negotiate with local GP commissioners or the trust.

Mr Broome said he had quit because patients were being denied care on financial rather than clinical grounds, and because the hospital had attempted to gag him from publicly voicing his fears about patient safety.

The trust, which encompasses the Cumberland Infirmary in Carlisle and the West Cumberland Hospital in Whitehaven, is currently grappling with a cost improvement target of around £15m, but insisted all decisions on care were clinically assessed.

Mr Broome said: ‘It got to a point where from the consultants' point of view, patient safety and quality were adversely affected. When GP commissioners took over, initially I was very hopeful and had some constructive meetings on pathways.'

‘But they are starving us of funds. I've got a patient who has been cancelled six times for a knee replacement. I've had quite a few cancelled more than four times.'

Mr Broome claimed the hospital trust had attempted to prevent him from speaking to the media or the NHS scrutiny committee about his concerns.

Dr Peter Weaving, a GP in Brampton and joint chair of NHS Cumbria's clinical senate, said GP commissioners were trying to make decisions with the agreement of consultants, but that they had to be aware of the financial restraints.

‘We have frequent discussions with management and consultants. If they feel there are safety issues, they should be raised at these meetings,' he said.

‘There seems to be a lack of awareness of the substantial financial subsidies north Cumbria has had year after year. We are spending money we don't have.'

A hospital trust spokesperson said: ‘We have been working closely with clinical teams to become more efficient, but we have been clear this will not be to the detriment of patient quality and safety.'

On the allegation of gagging, the spokesperson added: ‘There are clear guidelines in the trust regarding the way we communicate with the media.'

'Mr Broome has had two cancellations since April 2011 – one because an orthopaedic emergency took priority and one because medical notes could not be located in time.'

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READERS' COMMENTS

Vinci Ho, GP Partner,
13 Dec 2011
As I said many times , the hidden agenda under all the health reforms pushed forward by this government is all about blind cost cutting , nothing more , nothing less.
Yes , some of us might have some wishful thinking about the Health Bill in the first place and I see nothing wrong with that . But the demons are the politicians who are trying disguise a total money saving exercise as 'reforms' to make things better.
So much has already been cut to eradicate ' bureacracy ' (really?) , more cuts now is by any ordinary person's intelligence , is jeopardising patients' well beings .Even my old mother understands that.........
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Anonymous, PCT,
13 Dec 2011
Dr Weaving is already talking like a bean counter - 'spending money we don't have'......all you good Doctors who spent years training to save people's lives should monitor what you say. Once you start saying stuff like 'we need to cut referral rates' and 'we are subsidising the local trust to the tune of..'...start worrying. You are a scarce, expensive, vital resource - what should you be doing?

PCT Finance Manager
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David Snape, Other healthcare professional,
13 Dec 2011
To state the obvious, any National Health service is an extremely expensive facility and will become more so in the future as medical intervention increases in conjunction with increased patient demand. I therefore see nothing wrong in attempting to make the system more efficient and cost productive. The reason the World economy is in dire straights is because of spending money we do not have or can not generate.
There are undoubted ineffecienies within Secondary Care (as is true across the whole Health Service) and it is not unreasonable to apply filters to a referral system so that the appropriate patients are only seen by the most appropriate clinician, as long as there are systems in place to ensure adequate patient safety.
The Nation can not afford to permit things to continue as they have in the past.
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Andrew Bamji, Consultant,
13 Dec 2011
Mr Broome's situation is all the more worrying because up until recently the major problems have been in the South.

Stopping referrals other than by asking GPs to exercise self-restraint (which I am sure they do) is a high risk strategy. However we have to decide whether our prime function is to provide a clinially appropriate service or to live within our means, as it is clear that the two are mutually exclusive.

Today "The Times" reports major financial problems exist in almost all the London hospitals. It is beyond belief that all of them are financially incompetent. The only other explanation for wholesale failure is that something is wrong with the funding system - which I have been saying for years. Furthermore if hospital costs can be reduced by increasing "Care in the Community" where is the evidence that this is overall any cheaper? And if GPs are so financially challenged that they must withdraw hospital funding, where is the money to fund the increased care in the community?

At least Mr Broome appears to have been discussing things directly; in my part of the woods managers talked to managers and imposed their decisions on both hospital consultants and GPs despite loud protests.

The answer to the problem of widespread financial breakdown (which it is) is either formally to ration healthcare or radically to alter funding; abandoning the IT programme will help, but abolition of the purchaser-provider split will free up sackloads of money by removing the need for layers of financial managers. And then of course there is PFI...
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Marie-Louise Irvine, GP Partner,
13 Dec 2011
I agree with the comments by anonymous PCT and Dr Bamji. When you see a phrase like " We are spending money we don't have." you should ask "Why don't you have the money?". It's clear that health is not being adequately funded. Health is expensive , but its money well spent compared with many of the things we waste millions on. Hospitals need to be adequately funded, as does primary care, as do community services. Getting rid of PbR, purchaser -provider split etc will save billions. The health select committee in 2010 estimated that the main reason for the rise in NHS admin costs from 5% of the health budget in 1990 to 14% in 2005 was due to the internal market with its attendant transactions. Think how many more transactions with the full blown market envisaged by the H&SC bill? All that advertising, tendering, monitoring, billing, accounting - not to mention the legal challenges and you can see how 14% will soon become 20% or 30%. We could soon end up spending 30% of our health budget on administration as they do in the USA. The health select committee was not a bunch of lefties - they were an all party committee who judged that the purchaser-provider split had not been a success but was in fact a "costly failure". its time to look at the way Scotland and Wales are running their NHS - no PbR, no FTs, no commissioning, no purchasers or providers - just planning based on health needs. This would meet Cumbria's needs far better than the existing arrangement - and to think pro-bill GPs have been trumpeting about Cumbria as a fantastic example of how GP commissioning is working! Yes - you get to be commissioners but your local hospitals collapse - happy now?
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Anonymous, PCT,
14 Dec 2011
Spot on Dr Irvine - Comm/Provider isn't a game that gives win win situations. There is an enormous layer of bureaucracy associated with contracts and the associated monitoring and reporting.

Hospitals need to be efficient and offer high quality services. How this is possble with income based mostly on activity is beyond me. The incentive is clearly there to trade your way out of trouble. Over the other side of the fence sits the GP gatekeeper who's new job is to do the exact opposite. Hospital services should be properly planned. Instead it blows around amidst the government's mad marketplace.

PCT Finance Manager
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Anonymous, Other nurse,
14 Dec 2011
Absolutely - the purchaser/provider split and the insane amounts of money spent on administering it is criminal. Give clinicians in the community and in hospitals money and let them run services, with appropriate admin support - they are the ones who know what's needed, not the "bean counters" who try to impose a business model on a health service which needs to be flexible and responsive to individual health needs rather than expecting all episodes of care to be standardised. Of course some regional and national planning of service levels is needed, but please stop, for example, the nonsensical situation where, if I need to refer to another hospital department, instead of doing so by phone, immediately, I have to write and beg the patient's GP to refer them in to a system which will add another 10-18 weeks to their wait for treatment.
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