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Complaints as referral management centre diverts patients to out-of-town ISTCs

Exclusive A referral management centre has attracted more than 100 complaints from GPs and patients angered after referrals were diverted to privately run secondary care services situated up to 30 miles out of town, a Pulse investigation reveals.

NHS Swindon has attracted fierce criticism after appearing to use its referral gateway to over- ride patient choice and send patients to a group of three independent-sector treatment centres (ISTCs) run by private pro- vider UK Specialist Hospitals.

GPs elsewhere have been placed under pressure to send patients to privately run services offered under block contracts, but this is the first instance where evidence has emerged of patients being diverted against their will by a referral gateway.

It comes as leading medical organisations threw their weight behind Pulse's A right to refer campaign, which is fighting against unacceptable infringements of GPs' clinical freedom, demanding gateways are put to a CCG ballot and calling for funding for GP peer review.

NHS Swindon revealed under the Freedom of Information Act it had received 108 complaints about its referral gateway – which screens GP dermatology, back pain and ophthalmology referrals – specifically related to diversion of referrals to ISTCs.

There have been 42 complaints already in 2011/12 and were 56 in 2010/11. In December 2010, the PCT admitted use of the ISTCs, all between 20 and 30 miles from Swindon, was only running at 80% of its target. Under a £2.7m deal guaranteeing UK Specialist Hospitals 94% of contract value regardless of use, the PCT paid out £2.1m for £1.7m-worth of services.

At the time, NHS Swindon said ‘actions are being taken to increase ISTC utilisation'. PCT board papers now project overuse of ISTCs, with end-of-year use at 105.3%, more than 20% over this year's guaranteed contract value of 83.5%.

Dr Gavin Jamie, a GP in Swindon, said the ISTC contract had been ‘parachuted in from London': ‘We were told our money was going to the ISTC, so it becomes a case of patients diverted to follow the money, whereas we were always told it was going to be the other way round.'

Dr Nigel Watson, chief executive of Wessex LMCs, said: ‘In many areas services have been removed from acute trusts and put in ISTCs, sometimes without support of GPs or patients. In places like Swindon referrals got diverted, but patients weren't always keen.'

Dr Chaand Nagpaul, GPC negotiator, said: ‘Complaints suggest decisions are being taken without the patient's involvement or wishes. Patients are paying the price for a political ideology that resulted in block-funded contracts for ISTCs.'

An NHS Swindon spokesperson said: ‘We're pleased that for the past six months we've been referring the number of patients expected in our contract to local ISTCs. Patients choose their own path as long as that choice provides the service required. All complaints are investigated.'


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