GP referrals to A&E should require doctor assessment, say GP leaders

GP leaders have urged the Government to require hospitals to ensure that any patient referred by a GP to A&E is assessed by a doctor.

The Doctors’ Association UK (DAUK) has written to health secretary James Murray asking him to introduce ‘a new set of standards’ – including allowing no undifferentiated patient to be assessed or discharged without a doctor’s approval. 

It follows the deaths of two children who were seen by advanced practitioners after being referred to A&E with suspected appendicitis. 

Eight-year-old Ethan Hanson died last year after a GP referred him to hospital, where he was ultimately discharged after an advanced nurse practitioner mistook appendicitis for constipation. 

And a coroner found that nine-year-old Dylan Cope, who died in 2022, had not been assessed by a doctor and a written referral from his GP was not acted upon appropriately. 

DAUK GP co-leads Dr Sarah Jacques and Dr Steve Taylor said in their letter: ‘When a GP refers a patient to hospital, that referral represents a clinical judgment that is the equivalent of a medical consultant opinion in the community, and thus necessitates a further medical assessment. 

‘It is deeply concerning that such referrals can result in decisions being made by non-doctors regarding their care or discharge before they are reviewed by a doctor.’ 

They called on the Government to ‘introduce a new set of standards’ to ensure: 

• Ensure any patient referred by a community GP to hospital by a GP must be assessed by a doctor in the hospital; 

• No patient presenting with undifferentiated (undiagnosed) symptoms should be allowed to be assessed or discharged without the approval of a doctor; 

• Review the current status of assessments in emergency departments to ensure patient safety is the priority and that doctors are involved in all cases of undifferentiated care and GP referrals. 

Following Ethan’s death, a coroner wrote to the RCGP expressing concern that GPs ‘may not be aware of the implications of referral route on triage and assessment in local hospitals’.

The RCGP said it acknowledged ‘challenges’ in information sharing between primary and secondary care.

However, Dr Taylor told Pulse the key issue in the case was that once Ethan arrived at the hospital, he was seen by an ANP rather than a doctor.