GP referrals surge threatens Government's 18-week target

02 Mar 09

Managers have begun moves to cut primary care budgets after the rising tide of referrals combined with a busy winter to cripple NHS budgets.

Figures released last week showed GP referrals jumped sharply for the third successive quarter, with an 11% rise year on year from October to December.

NHS Hammersmith and Fulham PCT said it was planning to ‘reduce the number of enhanced services’ it offered and cut spending on its QOF-plus scheme, which pays for hitting tough targets for asthma, cervical screening and heart disease.

The trust said ‘winter pressures’ and the referrals crisis now left it at risk of missing the 18-week target, which is regarded as a must-do by NHS managers.

NHS Bury also said a local increase in GP referrals of 13% was having a serious impact on its ability to hit the 18-week target, with hospital workers having to work overtime to bring down waiting lists.

‘This is raising basic questions around capacity and the provider’s ability to have a safe operating environment with a motivated workforce,’ a report by the PCT said.

NHS Bedfordshire also said GP referrals continued above what it had planned for and that its overspend on hospitals stood at £7.35m last month, with one hospital having to outsource work to meet its targets.

But GPC negotiator Dr Chaand Nagpaul said any plans to cut primary care budgets could prove counter-productive for PCT budgets.

‘The solution to reducing demand is a strong primary care base and it would be unfortunate if PCTs tried to solve the problem by cutting primary care budgets. This could actually exacerbate rather than help the problem,’ he said.

Dr Kailash Chand, a GPC member and GP in Ashton-under-Lyne, Lancashire, said the increase in referrals was often generated from secondary care. ‘There have been increasing consultant to consultant referrals and consultants sending patients back to us to refer to the physiotherapist,’ he argued.

The latest national rise in referrals has slowed slightly, following rises of 16% and a 13% rise in quarters one and two last year, but will still intensify pressure on PCTs to launch incentives schemes to bring down GP referrals.

Pulse has learned that schemes in South East Essex, Brent and Wiltshire will all be recommissioned, with a further scheme in NHS Torbay still under review. We revealed last week that a controversial scheme in Oxfordshire had already been recommissioned.