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Joanna Clarke-Jones

GPs are demanding clarity over where legal responsibility lies after they have made a referral, because PCTs and hospitals are increasingly bouncing patients back.

Trusts around the country are implementing referral management centres, triage units or setting referral limits in order to cut costs.

But GPs are worried they will be legally liable if patients who they have referred but who are sent back to them suffer because they have not received timely or appropriate care.

The GPC is understood to be considering a series of cases raised by LMCs in areas where referrals are being limited.

PCTs in East Sussex have written to GPs asking them to sign a letter authorising the trust to redirect referrals.

Dr James Gillgrass, chief executive of Surrey and Sussex LMCs, said the LMC was advising GPs not to sign the letters. 'Our concern is whether this returns the legal responsibility for the referral to the GP,' he said.

Dr Gillgrass said the LMC had also raised concerns over confidentiality if people within a PCT had access to a letter intended for a specific consultant.

Dr Nigel Watson, chief executive of Wessex LMCs, said GPs were no longer able to refer to neurology departments in Portsmouth and were having to send patients to London.

Similar problems were being faced in Wiltshire with orthopaedic referrals, and in Southampton doctors couldn't refer to spinal surgeons, he added.

Dr Watson said: 'The trusts have said "sorry GPs it's back to you, you need to sort it out". They seem to think they can just send referrals back. But we need to establish the legal position.'

Further problems have been reported in Luton where GPs have been told all referrals not marked urgent will be returned to the PCT to be 'assessed for treatment within primary care'.

Dr John Canning, chair of the GPC contracts and performance sub-committee, said: 'GPs must not be left holding the baby. They must take it up with the LMC and make clear to the PCT they are not going to take responsibility for the PCT's failure to commission services properly.'

Dr Canning said GPs should not sign anything unless it was made clear that the responsibility lay with the PCT to find alternative provision. GPs should advise patients if there was a problem, and treat them until a referral was made.

What GPs should do:

GPs must keep all paperwork relating to their referrals, Dr Sherry Williams, deputy

director of policy at the

Medical Protection Society advises.

She said: 'If something gets batted back to the GP, they have to show they have done the best they can to get the patient secondary care services.'

If the GP believed the patient could not be dealt with in primary care, they must inform the PCT of that, she said.

Dr Sherry added that GPs should consult their LMC or their

defence union if they felt uncomfortable with what they were being asked.

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