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Labour to allow patients to self-refer to secondary care

Labour to allow patients to self-refer to secondary care

GPs should focus on caring for patients ‘rather than the admin that comes with effectively running a small business’, which would involve patients being able to self-refer, the leader of the opposition has said.

In a piece published by the Telegraph at the weekend, Labour leader Sir Keir Starmer said that he wants to be ‘ruthless with the bureaucratic nonsense you encounter every day in the health service’ and that he will be pushing for patients to self-refer to secondary care without needing a referral from a GP.

It comes as GPs are seeking talks with the Labour Party over its ‘deeply concerning’ proposals to ‘tear up’ the GP contract in favour of a salaried service.

Last week, shadow health secretary Wes Streeting also laid out plans for patients to self-refer to secondary care, with GPs no longer the ‘sole gatekeeper’ for specialist services.

But some GPs said the proposals seemed to be ‘based on misinformation’ and ‘a lack of understanding.’

Sir Keir attacked ‘a decade of poor planning and platitudes’ by the Tories, which he said caused the situation for patients to become ‘intolerable and dangerous’, and argued that idea that the service is still ‘the envy of the world’ is ‘plainly wrong.’

He said that GP services were the ‘front door of the NHS’ and key to early intervention, but added that demand outstrips supply leading to the loss of GPs and practice closures.

Sir Keir wrote: ‘Quality care in the community provided by GPs is the difference between a diabetes patient living a happy, fulfilled life versus needing an emergency amputation. It is that stark.

‘But our primary care model isn’t working. Not enough young doctors want to take on its burdens and liabilities when older partners retire.

‘It’s time for us to think about a new, sustainable system, one that allows GPs to focus on caring for patients rather than the admin that comes with effectively running a small business.’

He said that he wants to ‘phase in a new system’ that sees GPs ‘fairly rewarded within the NHS, working much more closely with other parts of the system’.

He added: ‘Why can’t people with persistent back problems self-refer to physio? Why if you notice bleeding do you have to get a GP appointment, simply to get the tests that you then do yourself at home?’

Sir Keir said he was ‘[not] prepared to accept the idea that the NHS should somehow be off-limits, treated as a shrine rather than a service.

‘It is incumbent on those who want to fix it to be frank about what has gone wrong and how only a proper programme of reform and renewal will get us out of crisis.

‘There is no solution that doesn’t involve expanding the workforce. That’s why I have committed to doubling the number of graduating doctors and district nurses and providing thousands more training placements for nurses, midwives and health visitors.’

Dr Lizzie Toberty, who leads Doctors’ Association UK, said Sir Keir’s ideas could be ‘downright unsafe’ for patients.

She said: ‘Last week GPs took to social media in dismay, regarding Wes Streeting’s misguided ideas for general practice.

‘It was therefore unbelievable that Keir Starmer floated ideas which have already been tried, such as self-referral to physio, or which could be downright unsafe such as self-referral for testing for internal bleeding.

‘It is clear Labour leaders have not spoken to any doctors in developing their ideas, and it appears the NHS will be no better off under them than the current government.

‘As doctors who live and breath the NHS in our daily lives, we know the problems our patients are encountering, and more than that we know the likely solutions.

‘We are not the enemy here, we all want a health service of which we can be proud. We appeal to them, please go back to the drawing board and listen to us.’

Dr Ellen Welch, GP and co-chair of Doctors’ Association UK, said: ‘If you’ve got “internal bleeding” then you really don’t want to guess which tests you need or which specialists you should self-refer to – you may bleed to death while deciding.

‘Doctors train for ten years or more to become GPs to assess what’s going on and help patients in the best way possible. It’s shocking that Labour would suggest this. It puts patients at risk while simultaneously devaluing the expertise of GPs.’

Dr Martin Brunet, a GP and medical educator from Guildford, said on Twitter: ‘Self-referral to specialists is a terrible idea. This is because primary care and secondary have a totally different approach since we see a different cohort of patients.

‘Apply secondary care principles to the patients a GP sees and costs would skyrocket. Clogging up the secondary care system with unfiltered primary care patients will make it harder for genuine secondary care patients to get access, with delays to diagnosis and treatment a significant risk of patient harm.’

Last week, Prime Minister Rishi Sunak confirmed he has no interest in wholesale reorganisation of general practice in England, saying that what the NHS doesn’t need is ‘unfunded reorganisation buying out every single GP contract.’



Please note, only GPs are permitted to add comments to articles

Francesco Scaglioni 16 January, 2023 10:30 am

It would be extremely amusing if this were ever to go ahead. Give it one month and secondary care would be even more on its knees than it is at present. Give is a second month and the politicians would be be looking for a way to save face whilst reversing the plan

Malcolm Ridgway 16 January, 2023 10:36 am

With appropriate triage and services (eg physio led back pain service), this could work. Often as GPs it can feel like you are just bouncing through referrals (eg from opticians). Would need good controls but could reduce GP workload. We are looking at MSK digital triage and self referral – early days but we need to do something to stem the tide.

David Taylor 16 January, 2023 10:49 am

I think moving services out of hospital into primary care would be better – things like Podiatry, Physio, Occupational Health, Orthotics really shouldn’t be going through GP’s at all, and aren’t really secondary care either. However the idea that patients can self refer to specialists is just bonkers as we all know that the system will just get clogged up with the worried well trying to see Neurology/Gastroenterology/Rheumatology with vague numbness/paresthesia/bloating and joint pains

Richard Greenway 16 January, 2023 10:55 am

How to break NHS waiting lists completely.
GPs are already getting referrals rejected because not every box ticked of pre-investigation.
Fine for Physio, OT, Podiatry -but then you’d need to actually fund some NHS physios to provide capacity, and that’s not really secondary care as others say.
Suggest working on Retaining GPs first Mr Streeting- do some exit surveys.

Ian Haczewski 16 January, 2023 12:11 pm

Physio appointments as self referral I am happy with but open access to specialist services could be a disaster frankly , imagine self referrals for chest pain or shortness of breath without some sort of work up , abdominal pain cases , renal in origin perhaps not going straight to urology. It could be a real mess . To be honest many patients end up going to the right specialists because we have worked out accurately where they should be sent .
It beggars belief , that labour start off their campaign to improve the service , could in effect swamp it really quickly . For heavens sake get advice from those of us still in the service , while we are still here !

Bonglim Bong 16 January, 2023 12:55 pm

For every 20 people who attend with chest pain and worried about a heart attack – about 1 ends up being referred to acute chest pain clinic.

The only way it is going to work is to have someone else performing triage once people have self referred – like a specialist cardiac nurse.
But when a patient presents with chest pain from liver capsule pain from metastatic disease, is the the cardiology triage service going to be able to identify that from the history and examination and pick the right investigations to perform?

David Banner 16 January, 2023 1:47 pm

This is just a bit of populist kite-flying to appeal to voters but with no chance of being enacted in reality, same as the obviously daft and unaffordable (but publicly popular and headline grabbing) plan to end GP partnerships.
Mind you, the thought of our Consultant colleagues suddenly drowning in worried-well hell and realising just how much dreck we actually shield them from is deliciously devilish.

Michael Mullineux 16 January, 2023 1:58 pm

Might be sensible to ask experienced GPs for their thoughts, many well documented, as to how to improve declining access driven by the toxicity that working in the current NHS entails. Running a partnership certainly is not anywhere near the top of my list of administrative headaches. Spurious target driven micromanagement from NHSE, CQC, punitive Pensions, appraisals, a political system more concerned about survival and points scoring than addressing what the NHS in the 21st century can offer, repeat reorganistions and a callous disregard for those of us working in this mortally wounded behemoth are the issues we have been shouting about for decades. With our current crop of political masters, continued decline is inevitable and some may say part of the plan.

The Prime Minister 16 January, 2023 2:06 pm


Adam Crowther 16 January, 2023 2:30 pm

Looking forward to my healthy redundancy payment to being rehired 3-4 weeks later 😂 I am defo looking at acquiring“how to know which specialist to self refer” though 🤦🏼‍♂️

Truth Finder 16 January, 2023 3:00 pm

Only if patients are sensible but we know most are not. It is a way to break the NHS for good.

William Murray 16 January, 2023 3:00 pm

This could possibly beat Prime Minister Truss’s record breaking policy turnaround in October 2022 when a very poor thought out policy was put to the public arena and all hell broke loose in the money markets.This time all hell would break loose in secondary care outlets when deprived of primary care input..This is a classic example of how politicians in particular and the general public as a rule have no idea how the NHS works particularly general practice.Bring it on politicians!
I must also mention the fact that the vast majority of consultants don’t know either.

John Evans 16 January, 2023 4:40 pm

Commons – both sides – a cast completely lacking stars and talent – the same tired old rubbish, reheated and served up by a cast of egocentric Z list idiots.

Politicians’ sole interest in the NHS is a tool to use to access power so that they can get closer to the money pot to gorge themselves – second jobs, flip flopping property, pay increases of an order of magnitude higher than everyone else and seats on policy action groups.

The hideous waiting lists and patients dying waiting for an ambulance will expand the proportion of society affected by NHS funding beyond those unfortunate enough to have more serious or long-term illness. Societies values may change enough to lead to improvement.

It would have been better to have had a grown up discussion involving clinicians and not to have risked / suffered collapse of the system.

Some" Bloke 16 January, 2023 4:44 pm

ha ha ha… obviously torries are an easy target now, critisising them for crashing this or crashing that, and speaking about “a reform” in the nhs… but that boy Wes Streeting- he really is clueless. it’s the public who will suffer. shame…this used to be an ok country.

John Evans 16 January, 2023 5:14 pm

Moronic diatribe against Primary Care calling for improved efficiency or work harder – public eat it up.

‘Manage’ more patients per day = “too many remote consultations”, “can’t get an appointment with GP”, “lack of continuity”, etc

Perhaps the system would function better with fewer bright ideas / reorganisations and reducing bureaucracy related to CQC, appraisals etc. GPs could then continue to effectively manage appointments, resources and referrals according to need

Rogue 1 16 January, 2023 6:11 pm

The French used to allow this, until they go overwhelmed with inappropriate patients.
So they went back to all referrals through the GP.
(surprise that someone with medical knowledge actually send patients in the right direction!)

Keith M Laycock 17 January, 2023 1:51 am

It would be possible to go to great lengths to justifiably ridicule this latest alleged remedy for the agonal gasps of the NHS but, really, it is so meaningless that it would be waste of breath.

Muzakir Majeed 17 January, 2023 3:01 am

You are witnessing the crumbling of this (grand mess of a) Socialist Experiment. These political masters keep promising everything to everyone, with no clue as to who will pay for all these promises.

When the system crumbles (whist the “Leaders” of our profession, unions and regulators are a sleep on the wheels), society and its leaders may realise what they have lost. The bright side is, they may at least begin to see the value of the medical profession (beyond an election cycle), and pay them something remotely close to what they are worth.

Muzakir Majeed 17 January, 2023 3:11 am

Where is Patrufani Duffy? I miss her wisdom, whit and commentary….

David Mummery 17 January, 2023 8:58 am

Oh dear , Kier Starmer has dug himself into a hole with this one. I think really he should have spoken to his medical advisers and actually retract and correct some of what he has said . Kier if the ‘ internal bleeding’ is significant and someone is vomiting up loads of blood then maybe calling an ambulance is the right course of action?

SUBHASH BHATT 17 January, 2023 2:59 pm

Labour are not power . This is hypothetical at present. Lot will happen now and if and when labour govern country.

Scottish GP 18 January, 2023 6:30 am

Strange that Labour seems to have gone native with the Daily Mail. Shameful GP (victim) blaming for the NHS woes, populism at its worst.

Anonymous 18 January, 2023 7:22 pm

Elections are coming, they need to promise something. Happy to support it, less work for GP’s after all.

James Weems 18 January, 2023 11:06 pm

Wow. It’s truly mindless.

C Ovid 19 January, 2023 10:35 pm

Let them eat cake. I think self-referral is a great idea: it needs to be launched with a great flourish and then we can have a big slice of long-awaited schadenfreude, best served cold. We see a million every working day, no thanks for organising the all you can eat buffet. Only sad thing is people are going to get hurt… why did our leadership stop caring?