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NHS bosses warn against crude blocks on referrals

By Gareth Iacobucci

Crude referral caps being imposed by primary care organisations are an inappropriate way of dealing with the financial crisis facing the health service, say leading NHS managers.

The NHS Confederation said that automatically assuming that ‘low = good' in relation to GP referrals was an ‘over-simplification' of the process.

A new report, launched today at the NHS Confederation's annual conference in Liverpool, also contains the most tacit admission to date from NHS bosses that frontline services are ‘almost certain' to be hit by the biting cuts facing the NHS.

But in Dealing with the Downturn: using the evidence, NHS Confederation acting chief executive Nigel Edwards cautions against making simplistic assumptions about how to slash NHS costs, in a thinly veiled warning to trusts imposing referral caps and restrictions upon GPs, as revealed by Pulse last month.

‘While there is certainly significant scope for looking at referral rates, there is a tendency to assume that high = bad and low = good,' he says.

‘This is an over-simplification as a high rate might indicate better decision-making where GPs are identifying problems which need specialist advice that less insightful ones might miss.

'Low rates might mean that GPs have the ability to manage more patients locally or that they are missing important cases.'

Mr Edwards also warned against using ‘poorly chosen indicators' for measuring performance, which comes against the backdrop of many trusts using controversial balanced scorecards to scrutinise GP referral rates.

‘We need to deal with unwarranted variation but remain careful about bold claims derived from simple assumptions about changes in performance based on poorly chosen indicators,' he said.

The report says the sheer scale of the savings required means that ‘it is almost certain that frontline services will be affected'.

It also pours scorn on assumptions that financial savings will largely come from the acute sector, and claims that letting waiting lists grow will not save money, as well as posing ‘significant risks for patients'.

Mr Edwards said: 'The NHS today is facing the greatest ever challenge to the way it works and the way it cares for patients - now is the time for everyone working in our health service to rise to the challenge of providing improvements in care while also working more efficiently.'

NHS bosses warn against crude blocks on outpatient referrals

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