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Referral assault cuts numbers by up to a third

A series of privately run referral management centres and controversial PCT caps have prompted falls in GP referrals of as much as a third in just one year, a Pulse investigation reveals.

Earlier this month the Department of Health announced that GP referrals to hospital had fallen for the first time in six years, and trumpeted the reduction in hospital activity as ‘a clear sign that the NHS is working more effectively for patients and more efficiently for taxpayers'.

GP referrals fell 4.1% in the first quarter of this year, compared with the same period in 2010/11. But a Pulse analysis shows that much of the national decrease can be attributed to a handful of areas that have brought in tough and unpopular measures to curb GP referrals, including blanket referral caps and referral management centres run by private companies.

In south-west Essex, where GP-run private firm Fortis Healthcare runs a referral management centre, GP referrals have plummeted by 37% over the past year, although Essex LMCs chief executive Dr Brian Balmer attributed the fall to the

PCT's stringent referral cap implemented at the start of this year.

He said: ‘This massive drop was simply because the PCT stopped dead all referrals in the early part of 2011. It was done centrally – they told the acute trust that they wouldn't pay for referrals and activity dropped. It does not reflect GP behaviour.'

An NHS South West Essex spokesperson said the referral management centre had been used principally to divert patients to different care settings: ‘We are starting to see increased utilisation of community services as a result of the referral process.'

Elsewhere, NHS Manchester – which has a referral management centre run remotely by Harmoni – saw GP referrals drop by 15%, and in Hounslow, west London, where UnitedHealth began overseeing GP referrals in May after signing a deal with one of the first GP pathfinder consortia, referrals fell by 14%.

Dr Alick Munro, a GP in Hounslow and a member of Hounslow LMC, said the PCT had placed new restrictions on procedures such as bariatric surgery and minor surgery.

‘The thing that has made a difference to our referral behaviour has been the requirement to justify certain referrals to the detriment of patients,' Dr Munro said. ‘There's a longer delay for certain services, particularly counselling. I think that patients are noticing it.'

A UnitedHealth spokesperson said the service had been ‘designed by local clinicians' and was run by GPs and community staff.

Use the map to see where PCTs have forced down referrals