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PCTs tighten screw over GP referrals

By Gareth Iacobucci

GPs are facing tightening constraints over their referral decisions, with a new analysis revealing that a growing number of PCTs are using Practice Based Commissioning as a referral management tool.

More than a third (36%) of PCTs said they had already introduced new referral management arrangements as a result of PBC, with a further 43% currently with schemes in the pipeline.

The news comes as a major blow to GP PBC pioneers, who have consistently called for PCTs to give GPs control over referrals and the services they commission.

The report into PBC by the National Primary Care Research and Development Centre surveyed 73 PCTs, with only a fifth (22%) saying they had no plans to develop any form of referral management.

The study did not directly ask the intended purpose of arrangements, but 26 PCTs did provide details, with almost a third of these (31%) listing systems relating to ENT, dermatology and orthopaedics.

Only five (19%) specified that they were using ‘some form of practice level referral system', with three (12%) saying they had developed referral management centres.

National Association of Primary Care chair Dr James Kingsland, one of health minister Lord Darzi's advisers, described the results of the survey as ‘frightening'

He said: ‘PBC was about upskilling general practice and challenging referral patterns, not a PCT filtering the referrals. It doesn't challenge general practice to change and it's doomed to failure.'

Dr Michael Dixon, NHS Alliance chair, said some PCTs have ‘unilaterally imposed referral schemes which clearly isn't within the spirit of PBC'.

He said: ‘Practice Based Commissioners need to be given the autonomy and the reigns to commission, and ensure that they take ultimate responsibility for referrals and demand management.'

Mark Sanford-Wood, a GP in North Devon and LMC chair, said referral management would only work ‘in collaboration with GPs who see that there's a need'.

He said: ‘If the PCT is occupied setting up demand management centres, then they're not going to be available to practices to help them develop some of the really interesting things that can come out of PBC. Of course it's going to impair it.'

Dr Ethie Kong, a GP in Brent and chair of a local PBC co-operative, was part of a group of GPs who resisted PCT overtures to centrally manage referrals, and said GPs must be given the autonomy to commission.

She said: ‘We opted for in-house demand management, where, for example, all dermatology referrals will be triaged by the GP with an interest in dermatology. I'm sorry, but we know our patients best.'

Dr Charles Alessi, a GP in Kingston, Surrey, and medical director of Kingston Co-operative Initiative said: ‘We need to get PCTs to appreciate that PBC is not simply setting up groups of GPs and imposing management structures upon them. Imposing a process could pose a clinical risk.'

Dr Ethie Kong: 'We know our patients best' Dr Ethie Kong: 'We know our patients best'

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