GPs’ right to pick up the phone and freely communicate with consultants should be protected, concludes a Government report that found evidence of hospitals ‘gaming’ the system to boost the number of appointments patients were expected to attend.
The review from the Cabinet Office found that patients were being inconvenienced because the lines of communication between medical professionals were not being preserved and called for this right to be protected by regulators, or enshrined in the NHS Constitution.
It also called for patients to be given the right to consultations by Skype, if GPs agreed, and for patients who move house to have the right to remain with their GP practice, irrespective of catchment area.
The review was commissioned to look at the barriers to patient choice in the NHS and found that hospitals favoured face-to-face appointments and were discouraging phone and email consultations – for which they received less revenue – even if this would save time and the patient would prefer this type of consultation.
It also found evidence that one hospital banned GPs from talking to consultants in case they discouraged them from arranging an appointment with a patient, when a quick phone call might save both patients and doctors time and create more capacity for the NHS as a whole.
The review was led by former Liberal Democrat candidate Mr David Boyle, and included roundtables across England, a call for evidence from stakeholders, a literature review and a survey by Ipsos MORI.
The review found about 36% of the population still found exercising choice difficult and that patients without internet or a car were ‘doubly disadvantaged’. Choice in healthcare was more accessible to the educated, confident and articulate, the review found, with women, non-white patients, renters and the unemployed identified as the groups most unable to exercise choice.
It recommended that hospitals were prevented from ‘gaming’ the system in order to increase their income.
It said: ‘Long term hospital outpatients are often expected to travel to see their consultant at regular six month intervals when they are quite well, but are unable to see them when they really need to.
‘Some kinds of behaviour may also need to be ruled out by NHS regulators under the NHS constitution. In particular, free communication between doctors and patients and between professionals, needs to be protected.’
After the review heard of perverse incentives such as hospitals gaining revenue by referring patients back to their GP rather than straight on to a specialist within the hospital, or booking patients into phantom appointments which are later cancelled so as not to breach waiting time targets, an evaluation into the prevalence of gaming in the Choose and Book system was also recommended.
The review recommended that patients who move house should have the right to remain with their GP practice, irrespective of catchment area, though said that decisions about this issue would need to wait until the results of the GP Choice pilots were published.
It says: ‘Consideration should be given to drawing up town or city specific catchment areas for this purpose while lessons from the GP Choice pilots are being learned.’
Where both sides agree it is appropriate, patients should have a right under the NHS Constitution to ask for consultations with GPs using a range of communication methods, such as telephone or Skype, it added.
Dr Peter Holden, a GPC negotiator and a GP in Matlock in Derbyshire agreed that GPs should be free to talk to hospital consultants.
He said: ‘GPs need to consult with consultants as much as patients. The pen pushers should stick to pen pushing. Managerial greed is inappropriate to come in the way of healthcare, and that is what this is: managerial and trust greed.’
He added that the proposals for removing all practice boundaries were unworkable.
He said: ‘What the policy wonks don’t understand is that there is a good reason for boundaries. If I’ve got a patient 25 miles away, then going to visit them will take time and degrade the service for all.
‘General practice is a team activity and I might require the opinion of a team member who may not have the geographical freedom a GP has.
‘The bottom line is that choice costs resources and implies a surplus of resources which currently the NHS just doesn’t have.’