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Independents' Day

The real reason for rocketing referral rates

Last week's article 'PCTs to slash spending after rocketing GP referrals' stated there was 'no clear reason identified for the rapid rise of referrals'.

In my area there are some simple reasons why referral rates have increased, all related to the recent changes in NHS policy that affect how our local trust deals with the process of patient care. Some of the mechanisms are subtle and therefore very difficult to measure. None is the fault of GPs.

Many surgical patients now have no follow-up planned at our local hospital and it is not uncommon to have to re-refer patients to be reviewed postoperatively if problems arise, as no formal post-operative review mechanism has been established.

Until recently, a sizable number of patients reluctantly decided to pay for their care when outpatient waits were longer. But now waiting times to first appointment are shorter, this group of patients seems to have vanished, returning to the NHS sector as extra referrals.

A plethora of new guidelines seem to have been influenced mainly by secondary care and hence often underestimate the skills in primary care. They reinforce the hospital role by requiring referral for investigations or opinion. The recent Manual for Cancer Services 2008: Skin measures is a prime example, stopping most GPs operating on simple skin cancers.

Locally we find patients are often discharged earlier from outpatient clinics with a list of suggestions for GPs regarding ongoing care. This facilitates 18-week access and brings care back earlier within the jurisdiction of general practice. Although it brings benefits for many patients it inevitably results in more being re-referred for further advice.

I am sure this list is not exhaustive in explaining why GP referral rates are increasing. Sadly I am sure that general practice will continue to be blamed for spurious NHS statistics.

From Dr David Chesover, Maidstone, Kent

No wonder referrals are up. Our district hospital insists on 'new referrals' for everything, even for patients already attending. This week I had to refer a patient who is being followed up after a recent melanoma excision and has another worrying lesion, which the consultant has commented on, but won't look at until I refer her again! This goes on all the time.

What's more, consultants won't refer between themselves. And we have stopped doing minor operations as they don't pay enough to cover our costs.

From Dr Ann Bowman, Blackburn, Lancashire

It's no surprise that referrals are up when pre-operative assessment clinics are cancelling patients for minor medical problems.

The patient is asked to go back to their GP, who has to see them and refer them again. The net result is double the referrals for exactly the same problem.

From Dr Alun Davies, Llanelli, South Wales

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