GPs will have to seek permission from a privately-operated referral management service – who have the power to overrule them – as part of a CCG scheme to cut unnecessary outpatient appointments.
NHS North Durham CCG have signed a contract with private provider About Health, which employs NHS consultants and GPSIs to review referral letters at a price of £10 a time.
The ‘rapid specialist opinion’ (RSO) service is expected to take up to three working days to deliver a verdict on a referral, GPs have a right to appeal a decision, and can have a subsequent review by an independent consultant.
The CCG told Pulse the decision was taken on the basis that an unnecessary referral costs on average ‘around £150’ and said that outpatient appointments should usually be reserved for when ‘practice and community based solutions have been tried’.
GP leaders have condemned the plans as a ‘total disgrace’, and a fundamental misunderstanding of the role of general practice.
The RSO service will decide whether, based on CCG guidelines, a case should be referred to specialists in cardiology, gynaecology, dermatology, ENT, ophthalmology and gastroenterology – though additional specialties could be added in future.
Urgent cases and patients with suspected cancer are not sent through referral triage, and the CCG has confirmed that legal responsibility for clinical decisions made at triage will sit with the service.
An FAQ on the CCG website states: ‘The specialist team will provide clinical triage within two working days of the referral being sent, and then the outcome will be processed within one further working day.’
It continues that this will ‘sometimes be faster’ and that the CCG will monitor the process, but it does not ‘envisage this causing a delay in treatment.’
It states: ‘Where a GP disagrees with the decision they will have to submit a further referral challenging it, if the service again rejects their referral, the decision will then be considered by an ‘independent specialist.’
The BMA’s GP Clinical lead Dr Andrew Green told Pulse the service was a ‘mechanistic view of general practice’, and warned it was irresponsible to undermine the professionalism of GPs while the profession was struggling to recruit.
He added: ‘I personally think it’s a total disgrace, GPs are independent professionals, trained to a very high standard, and the decision to refer is made in consultation with the patient, when both patient and GP believe it’s in the best interest of the patient to do so.
‘To think that a consultant, however skilled they are in their specialty, has any understanding of the interaction that goes on prior to the outpatient appointment, displays a fundamental misunderstanding of general practice.’
A spokesperson for NHS North Durham CCG told Pulse: ‘The aim of this service is to ensure patients are receiving the most appropriate treatment for their condition in the most appropriate place. Hospital outpatient appointments should usually only be made when available practice and community based solutions have been tried.
’The specialists and consultants are NHS professionals from outside of the North Durham area contracted to work for “About Health”. Referral letters will be looked at by consultants/specialists and are reviewed in the light of the agreed clinical guidelines.
‘About Health have confirmed when a clinical decision is made at triage the responsibility sits with them and they have clinical negligence cover for this.’
City of Durham MP Roberta Blackman-Woods has said she will raise the issue in Parliament.