Trusts in various parts of England are making ‘conscious decisions’ to send more neurology referrals back to GPs to manage, Pulse has found out.
Pulse understands that a national shortage of consultant neurologists is leading to several areas having to restrict or ‘vet’ referrals from GPs, with the cases being sent back to primary care.
One trust put out a statement saying that this was being done because of ‘patient care and safety’, as referrals were taking over six months to be seen.
GPs have said that this amounts to introducing advice and guidance ‘by stealth’ – under A&G services, GPs access specialist advice by telephone or IT platforms rather than referring patients for a hospital investigation.
Pulse has learnt that a trust in Nottingham has made a ‘conscious decision’ to return more referrals with advice, while one in Kent has had to temporarily stop accepting neurology referrals due to increased staff absences.
The statement by Nottingham University Hospitals, shared by GPs on Twitter, said: ‘Neurology has made a conscious decision to carefully vet all referrals from primary and secondary care.
‘You will have noticed a much higher proportion of neurology referrals now get returned with advice. Please be assured the sole driver for this is patient care and safety.’
Without the new system in place, referral waits would be over six months and patients would not be seen ‘in a timely manner’, it added.
It said: ‘Whilst it is recognised that a formal neurology review will always help reassure patients, the capacity is not available to arrange reviews purely to relieve anxiety anymore and this is unlikely to change for the foreseeable future.’
Local GPs said there were particular concerns over neurological symptoms which is an area they have little knowledge of.
Dr Irfan Malik, a GP in Nottingham said: ‘We have been struggling with neurology referrals for several months with advice given or rejected. Then last week the neuro team put out a statement. This was the first official response we had seen.’
He added that it was A&G by default and warned that GPs could be held responsible if patients fall through the cracks.
He said: ‘We are not very happy about their explanations. There is also the risk element of a missed diagnosis after neuro advice or rejection – will the specialist carry the can? Or will they blame the GP?’
Nottinghamshire LMC treasurer Dr Jen Moss Langfield said that local GPs were supportive of their secondary care colleagues, but added they ‘weren’t informed about this in advance’.
She added: ‘It’s a move to referrals via advice and guidance by stealth. There are questions around safety and moving the responsibility and risk into general practice.’
She added that GPs would only refer when they really needed to and some patients may have diagnoses that end up being missed, especially those with subtler symptoms.
Dr Jonathan Evans, consultant neurologist at Nottingham University Hospitals, said the issue was not principally about capacity but ‘about recognising what a secondary and tertiary referral service is for, where the added value of a neurologist comes, and streamlining our services to be able to deliver this as promptly as we are able.’
He added that his colleagues would be happy to respond to any feedback from GPs about the approach.
Meanwhile, in Medway and Swale in Kent, routine neurology referrals have been suspended until further notice ‘due to unforeseen issues’, with GPs provided with an advice and guidance (A&G) route for non-urgent cases.
Chief executive at Medway NHS Foundation Trust Dr George Findlay said: ‘Due to increased staff absence, routine neurology referrals are temporarily managed by other hospitals in Kent through the Neurology Assessment Service (NAS).
‘There is also a dedicated consultant-led hotline which allows GPs and hospital colleagues to access expert medical advice for patients with neurology conditions.’
Figures from the Royal College of Physicians for 2020/21 show that 51% of consultant neurologists in England report having locums filling staff vacancies and 38% reported unsuccessfully trying to appoint a consultant post in the past two years.
Earlier this month, Pulse reported an MDO warning that GPs could be held liable for advice given to them by hospital colleagues about their patients via ‘advice and guidance’ services.