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Non-doctors seeing up to half of GP referrals

By Nigel Praities

Exclusive: As many as half of specialists taking referrals from GPs at some hospitals are not medically qualified, a Pulse investigation reveals.

Our findings from 65 NHS trusts reveal the expanding use of non-medical specialists in Britain's hospitals and the proliferation of non-medical ‘consultant' positions.

But at 40% of NHS trusts, there is no policy requiring hospital staff to inform patients that the person they are seeing is not a doctor.

Many trusts instead said they expected patients to be able to judge the qualifications of staff from their uniforms or to read their name badges.

The findings will fuel fears that the rising use of non-medical specialists has occurred in many areas without the involvement and agreement of GPs.

As many as 36% of trusts admitted they did not allow referring GPs to request that a patient be seen by a medical specialist, rather than a specialist nurse, psychologist or allied health professional.

The data, gathered through the Freedom of Information Act, has revealed vast variation in the employment of non-medical staff to take referrals from GPs, and over the safeguards governing their use.

At the average hospital, 28% of hospital specialists – defined as those who take GP referrals and manage their own caseload – are not medically qualified. But in some trusts that figure is zero, whereas at others it is 50% or even higher.

As many as 41% of NHS trusts reported their use of non-medical specialists had risen over the past two years, compared with 28% where it had fallen.

At Southend Hospital NHS Trust, the proportion of non-medical specialists has increased from 40% to 48% in three years and it now has five non-doctors with consultant titles.

And at Birmingham Children's Hospital, non-doctors make up 78% of specialist positions, and 10 hold consultant titles.

In contrast, hospitals in Harrogate, Coventry and Sherwood in Nottinghamshire all said they had no non-medical specialists.

The lack of consistency over policies to oversee use of non-medical specialists, and particularly the fact patients are kept in the dark in many areas, was described as ‘scary' by GPs.

Dr Brian Balmer, chief executive of Essex LMCs, said there was a risk patients would be misled about who was carrying out their care.

‘As a patient, I'd like to know who was putting their hands on me. I am always telling people what I am not. I am not a dentist so I am going to cock this one up – they understand that pretty well,' he said.

Dr Jonathan Fielden, chair of the BMA's consultants committee, said use of non-medically trained specialist staff was appropriate for some referrals, but the key was to involve local doctors.

‘Occasionally, being seen by a physiotherapist for back pain or knee pain, for instance, may well be the best thing, as long as that pathway is agreed between consultants and GPs and patients understand why,' he said.

Trusts say they expect patients to distinguish staff by their uniforms Trusts say they expect patients to distinguish staff by their uniforms Find out what's happening in your area

To view our interactive map of the proportion of non-medical specialists in hospitals across the country, please click here.

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