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BMA calls for withdrawal of peer review scheme as GP referrals decline

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Exclusive New peer review schemes are ‘focusing on the wrong target’, GP leaders have said, as official NHS data showed GP referrals to hospitals are actually in decline.

NHS England papers, published ahead of yesterday’s board meeting, showed that GP referral growth reduced, by -1.1%, for the year to date (April-July) which is ‘below the long term growth rate of 4.0- 5.0%’.

Meanwhile, NHS England figures published in August showed GP referrals decreased by around 0.5% in the year to July, compared with the previous year – while referrals from elsewhere increased.

This comes as advice issued by NHS England, recently unveiled by Pulse, said all CCGs should instate weekly GP peer reviews of referrals by September this year.

BMA GP Committee chair Dr Richard Vautrey said: ‘This is something we have been saying to NHS England and others in relation to the peer referral scheme. That it is a focus on the wrong target.

‘GPs have been working hard to ensure that referrals to hospital are appropriate and they are not a source of a large rise in activity in hospitals.

‘These figures seem to confirm that. The pressures in hospital are for a variety of reasons, not least people living longer, becoming more frail and needing more care.’

NHS England is hoping that its peer review programme will reduce GP referrals by 30%, however this comes as a review into a similar scheme run by NHS Basildon and Brentwood CCG showed GP referrals rose by close to one fifth while it was in operation.

The review, carried out last November, led the CCG to drop the scheme but it has told Pulse it is now reinstating peer review based on NHS England’s guidance.

A CCG spokesperson said: ‘The review showed that while the scheme was in operation referrals from GPs rose by 17%. At an annual cost of £285,000 for the CCG, the CCG… decided to end the scheme.

But they added: ‘The CCG is on course to have a scheme in line with the NHS England guidance in place by the 1 October 2017.’

Essex LMC deputy chief executive Dr Andrew Bradshaw said the LMC was ‘not consulted’ on the scheme, adding: ‘Any scheme devised and funded locally would still be voluntary. It should be clinically led by practices and not the subject of external imposition or diktat.’

Dr Alistair Lipp, medical director for NHS England Midlands and East said: ‘Clinical peer reviews are a simple way for GPs to support each other and help patients get the best care, from the right person, at the right time without having to make unnecessary trips to hospital.

‘NHS England issued guidance on these nationally for CCGs and Basildon and Brentwood CCG have reinstated these reviews in line with this guidance.’

Nottinghamshire LMC said in a letter to GPs that they had called on NHS England to withdraw its advice, and also said practices should regard schemes as ‘voluntary’.

Meanwhile, a pilot scheme for GP peer review in the North East of England saw GPs forced to seek approval for routine referrals from a team of GPs and GPSIs.