GPs in some areas are being asked to sign off on all locum referrals as part of incentive schemes designed to cut outpatient appointments, Pulse’s ‘Cash for cuts’ investigation has revealed.
NHS Rotherham CCG has included in its ’quality contract’ a requirement for substantive GP sign off on all short-term locum referrals to secondary care.
And in East Berkshire, three CCGs covering Windsor, Ascot, Slough and Bracknell have signed up to a locally commissioned service which encourages GPs to triage referrals – in particularly the partner or lead GP is required to review all referrals generated by locums.
The schemes have been criticised by sessional GPs leaders, who say that schemes such as these ’further the fallacy that locums are second class doctors’.
In a response to a freedom of information request on schemes to reduce referrals, NHS Rotherham CCG said its ‘quality contract’ included GP partners signing off locum referrals.
The FOI said: ’Practices will be expected to reflect on current referral behaviour within the practice and in particular to have substantive GP sign off of all short term (less than four weeks) locum referrals to secondary care. This includes an appropriate administration system signed off by the substantive GP.’
It also includes cancer referrals as part of its targets for GPs to cut referrals.
Meanwhile, in East Berkshire, the FOI response said that, under the CCGs’ incentives scheme, ’the partner or lead GP is required to peer review all referrals generated by locum doctors to gate-keep referrals’.
Dr Zoe Norris, chair of the BMA GP Committee’s sessional subcommitte, said she would hope that when a practice engage a locum GP, they do so with a colleague they know, or have sufficient background information on to feel confident in their clinical skills.
‘If there are problems with referrals, I would expect practices to discuss this with the locum.
‘A blanket rule that all locum referrals must be reviewed and “signed off” seems to simply generate extra work for partners, and further the fallacy that locums are second class doctors.
She added: ‘I am all for feedback and learning opportunities but am not sure this is the way to do that.’
Dr Richard Fieldhouse, chair of the National Association of Sessional GPs, said CCGs clamping down on locum referrals in this way were ‘missing the point’.
He said he has never seen any evidence or data that that locums are more likely to refer unnecessarily in fact locums are more likely to diagnose cancer than a practice partner.
‘By seeing different GPs, you’re more likely to spot these things,’ he said.
And he added: ‘They are forgetting there is a patient in this who has had a referral blocked.’
Dr Fieldhouse said there could be a potential issue with locums being unaware of CCG or practice specific referral pathways or service but that could be easily solved with proper induction.
‘This is the wrong solution to this problem. We have produced an online electronic induction pack for practices to use so there is no excuse.’
Dr Dean Eggitt, chief executive officer of Doncaster LMC said there was a view at the commissioner level that ‘locums refer at the drop of a hat’.
He said there may be instances where locums may not understand what is available in primary care rather than referring to hospital but this was not the answer.
‘What they actually need is education and support.’
But BMA GP committee chair Dr Richard Vautrey said it could be seen as part of peer review and is not necessarily unreasonable.
‘It is possible a locum might not be aware of the systems in place – it is a practical solution to try and ensure local systems are used.’
More on the ‘Cash for cuts’ investigation
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