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GP spirometry referrals regularly rejected despite ICB guidance

GP spirometry referrals regularly rejected despite ICB guidance

Hospitals are regularly rejecting GP referrals for spirometry, in a breach of ICB guidance, an LMC has claimed.

GP leaders in Norfolk and Waveney have warned that rejected referrals are ‘unsafe’ as they mean patients are ‘missing out on being diagnosed or monitored’ for COPD or asthma.

In a letter to GP members, the LMC outlined that only some practices in the area are signed up to a spirometry locally commissioned service (LCS), and that those not signed up should be able to refer to acute trusts. 

Local GP leaders said they have been ‘assured’ by Norfolk and Waveney ICB that hospital trusts ‘should accept referrals’ from practices not signed up to the service. 

‘However, we know that this is not happening and that referrals for spirometry from these practices are being rejected,’ the LMC said. 

It has ‘repeatedly’ raised this issue with the ICB, and has called on local commissioners to ‘officially’ instruct all three local trusts to ensure referrals are not rejected. 

According to the letter, there have also been ‘inappropriate’ proposals for practices not signed up to the LCS to refer patients to other practices within their PCN. 

‘We have asked the ICB to kindly refrain from doing this and instead have direct robust conversation with secondary care to undertake this work, which they are contracted and funded to do.’ 

The LMC has produced a template letter for GP practices to use if their referrals are rejected, which highlights to acute trusts that spirometry is ‘outside of the General Medical Services contract’.

It also says: ‘The ICB has confirmed that your Trust is commissioned to provide this service and we have informed the patient of this. Please therefore accept this referral and do not reject. 

‘The Medical Director has been informed that GPs who are not signed up to the LCS are not able to do this uncontracted, unfunded work.’

Dr Ankit Kant, a GP in King’s Lynn, said the LMC had released a ‘great letter’ to stop ‘inappropriate rejections’, and that GPs ‘just need trusts to accept this now’.

‘Our team referred someone for spirometry (we are not commissioned) and a consultant has accused us of referring inappropriately and denying deserving patients appointments,’ he wrote in a post on X.

Dr Kant also said he has sent his local trust the BMA’s template workload rejection letter around 12 times since February, but that his practice continues to ‘get rejections each time’. 

Spirometry is not part of the core GP contract, and in Norfolk and Waveney the ICB has commissioned for it to be provided by some practices who are signed up to the LCS or by acute trusts. 

Last year, England GP leaders voted against a proposal to increase core funding to cover services such as spirometry. 

In its letter, the Norfolk and Waveney LMC highlighted that any practices signed up to the LCS must continue to provide spirometry in-house. 

Pulse has approached Norfolk and Waveney ICB, Norfolk and Norwich University Hospitals, The Queen Elizabeth Hospital King’s Lynn, and James Paget University Hospitals for comment. 

Last summer, GPs and respiratory specialists warned that patients are missing out on COPD diagnoses due to a ‘scandalous’ lack of spirometry services

Experts and charities told Pulse that there are huge gaps in provision around the country – a problem that has worsened since the pandemic – leaving COPD patients without the early intervention they need and likely increasing inequalities. 

And Asthma+Lung UK revealed that diagnoses of COPD had fallen by 51% in 2022 compared with pre-pandemic figures. 

The charity called for primary care to be properly funded to do spirometry, raising concerns about patchy provision. 


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