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Patient diagnoses delayed as trusts stall on referrals

Patient referrals are being delayed and mismanaged as primary care organisations struggle to cope with the effect of NHS deficits.

A Pulse investigation reveals intense frustration among GPs and consultants at long delays to referrals – in some cases by as much as 16 weeks.The investigation uncovered a catalogue of problems – including administrative hold-ups, bouncebacks and failures by specialist teams to flag up patients. In one case a PCT was refusing to allow patients to be referred to save cash.It follows a Pulse survey earlier in the month finding two-thirds of GPs were seeing their referrals inappropriately diverted by managers.Dr Tim Robson, a GP in Watford, said a patient of his with carpal tunnel syndrome had endured more than two years of pain because of a blocked referral for an operation. 'This operation would be day-case surgery, but a surgeon has told the patient he is not allowed to operate. I intend to contact my MP.' The delays are caused by cost-saving initiatives, he added.Dr Sue Ford, a GP in Cambridge, said administration problems in her local hospital meant staff refused to refer patients from one department to another – for example, from rheumatology to pain management – without first discharging them back to primary care. 'It's another link in the chain that can go wrong, and complicates the process,' she said.GPs' concerns were echoed by those working in secondary care. A consultant diabetologist told Pulse anonymously that referrals were being delayed by up to 16 weeks: 'Gatekeepers in general practice and PCTs are responsible. We're seeing more patients presenting later with complications of diabetes. The PCT is preventing referrals being made to save money.'A second consultant, who also wanted to be anonymous, said in some cases referrals were delayed for six or seven weeks: 'Choose and Book letters are rarely seen by me until the day of the outpatient appointment. This can mean patients are seen at inappropriate times or in inappropriate clinics.'Professor Anthony Barnett, clinical director of diabetes and endocrinology at Birmingham Heartland hospital, said it was the duty of GPs to take the issue up with their PCT.'The buck stops at the GP – if in their opinion the patient needs to see a hospital consultant, they should arrange it.'

Key criticisms of referrals process

• PCT and hospital trust cost-saving measures• PCT bureaucracy • Hospital administration• Failures by specialist teams to flag up patients

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