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At the heart of general practice since 1960

Private firm screening GP referrals remotely

By Ian Quinn

Exclusive: GP commissioners have signed up a private company situated hundreds of miles away to screen referrals from practices in a move one LMC leader described as a sign of the ‘new world' of general practice.

A service run by private firm Harmoni in Southampton has already flagged up thousands of referrals from GPs in Manchester for rejection or querying, and will also begin reviewing referrals in London.

NHS Manchester's referral gateway is the latest in a series of outsourcing schemes being launched across the country under Government moves to place tougher referral management at the heart of its NHS reforms.

Referrals are emailed to Harmoni administrators 250 miles away, who flag up those with concerns for review by a team of GPSIs back in Manchester.

GPs at 101 of 104 practices in Manchester have signed up to the scheme to review all hospital referrals for cardiology, urology, dermatology, ENT, gynaecology, general surgery, trauma and orthopaedics and ophthalmology.

It has begun to have a major impact, with more than 6% of referrals rejected or sent back to GPs for more information in the first three months. Of nearly 30,000, almost 2% were refused for falling outside commissioned services and 4.3% were sent back to GPs for more information. NHS managers claim the scheme has saved more than £2m in its first six months.

Duncan Cranmer, director of Harmoni, said: ‘The Manchester gateway was launched in the most rigorous way. We're starting to see much greater interest in systematic, systems-backed referral management, which we assume is triggered by the fundamental changes to the NHS. What's important to stress is local GPs make the decisions. Harmoni is providing support.'

NHS Manchester admitted a number of patients had successfully appealed against blocks on their treatment, but has nevertheless decided to widen the scope of the gateway to include further clinical conditions.

Dr Liam McGrogan, a GP in Manchester and chair of NHS Manchester's clinical commissioning committee, said: ‘Patients are being referred to the most appropriate service.'

Dr John Hughes, honorary secretary of Manchester LMC, said: ‘The LMC had some concerns, mainly about level of triage and number of bounce-backs. We've been reassured the process is using GPSIs and external back-up.'

But he said the LMC continued to harbour concerns, particularly over whether staff in Southampton would have access to sufficient information about NHS services in Manchester: ‘The fact it is in Southampton is controversial, but we were told IT and governance meant it would have cost three times as much locally. I'd like it in Manchester, but in the new world I'd expect this sort of thing more and more, with services outsourced to large companies.'

Harmoni has also been working with NHS Hillingdon to review referrals.

ENT is among a range of areas where referrals are being outsourced More on...

For the latest on GP commissioning click here.

Look at what referral management services are developing across England, and add any developments in your area.

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