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Anger as ‘ludicrious’ referral gateway rejects up to a quarter of GP requests

Exclusive GPs have been forced to formally complain to PCTs over a series of technical and administrative problems with referral management centres, with one practice claiming a quarter of its referrals have been rejected.

In NHS West Essex, GPs have been left frustrated by rejections and the insistence of administrators that referrals are resubmitted, sometimes several times, without having been triaged by its Central Referral Service.

Examples of rejections include a referral to a surgeon for diagnosis and removal of a lump refused because a minor surgery proforma was not attached, and a gynaecology referral refused ‘in error'.

A GP in Uttlesford, Essex, who wished not to be named, said: ‘I am vehemently opposed to referral management systems. It is intensely frustrating and is not working for administrative reasons and ludicrous technical problems.'

A practice manager at a practice in Essex claimed a quarter of its referrals had been rejected by the referral triage system: 'I feel our patients are suffering. So many receive letters stating their appointments have been cancelled.'

Dr Hugh Taylor, NHS West Essex commissioning lead for planned care, said: ‘Most GPs are generally satisfied with the Central Referral Service but we are aware of concerns. For the majority of the time it works extremely well. The average rate of rejection at the triage stage was just 7% in the first quarter of this year.'

Meanwhile Berkshire LMC has warned there have been ‘numerous' complaints from local GPs that ‘not all clinical information sent by referring GPs with their referral letter is being passed on by the administrative system to reviewing clinicians'.

It added: ‘The guidance that clinical reviewers are utilising is severely lacking in detail and specificity and may lead to inequity in interpretation and application.'

It comes after a Pulse investigation found PCTs using referral gateways were employing nurses, physiotherapists and podiatrists to screen GP referrals, prompting wide debate and national coverage.

Dr Ismat Nasiruddin, a GP in Balham, London, said: ‘I have experienced numerous cases of inappropriate triaging – leaving us to contain the risk and effectively wait for a disaster before they deem fit to intervene.'