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PCTs planning huge expansion in referral schemes

By Nigel Praities

PCTs are planning a big expansion in referral management schemes, prompting fears that GPs will see increasing numbers of their referrals bounced back or diverted.

Information obtained by Pulse under the Freedom of Information Act reveals the majority of PCTs already have at least one referral management scheme - and a third are planning to unleash more such schemes on GPs.

The revelation adds to the growing furore over GP referrals, with PCTs threatening to cut primary care budgets to help them cope with a 16% year-on-year increase in referrals.

The findings will stoke widespread GP fears that their clinical freedom to decide which patients need to see a specialist is being restricted by a growing number of schemes that use non-medically qualified staff to triage referrals.

One PCT told Pulse it already rejects a quarter of the GP referrals made under its scheme.

The information obtained from 92 PCTs found 51% had a referral management scheme, with the most popular specialities targeted being musculoskeletal and orthopaedic services (see box). Some 40% of trusts said they were reviewing their existing schemes and 34% were considering introducing new schemes.

While some schemes used GPSIs or consultants to assess referrals, others reported rejecting high numbers of referrals and bouncing them back to primary care.

Dr Kailash Chand, a GPC member and a GP in Ashton-under-Lyne, Lancashire, warned a delayed referral ‘could mean the difference between life and death'.

‘If they are about saving money and meeting PCT targets then I have serious concerns about them, but if they are clinically-led and are focused on directing referrals to the appropriate place, then I have no problem with them,' he said.

Dr Louise Warburton, a musculoskeletal GPSI who works in Shropshire, said she worked in a triage system and had only rejected one referral in the past year.

‘If you are worried about a referral then you should ring the GP and discuss it and not just send it back,' she said.

Oldham and Ealing PCTs have schemes that reject up to 5% of all GP referrals, while Havering PCT said it rejected a quarter of GP referrals made through its referral management scheme.

A GP in Havering, who did not want to be named, warned: ‘All our doctors have found it very frustrating. It's got to the point where I've written to the consultant and said, we'll refer this time, but it's a waste of our time and a waste of patients' time.'

Top specialties that PCTs are targeting

Rheumatology/Orthopaedics 45%
Dermatology 28%
Minor surgery 23%
ENT 18%
Urology 13%
Cardiology 12%
Physiotherapy 11%
Gastroenterology 9%
Other 28%

PCTs are planning a huge expansion in schemes to limit GPs' hospital referrals

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