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GPs receive ‘slap in the face’ over referral safeguards

Exclusive LMC leaders have been sidelined in negotiations over safeguards to controversial rationing policies to ensure GPs are able to refer to secondary care ‘when appropriate’.

NHS North Central London, which covers five PCTs, has apologised after unilaterally imposing a new ‘procedures of low clinical effectiveness’ policy on GPs despite previous commitments to review the policy with LMC leaders.

LMC leaders had been lobbying to get NHS North Central London to underpin the new policy with a series of principles – including a guarantee that ‘a GP must be able to directly refer to secondary care when this is in a GP’s opinion appropriate’, but the PCT cluster imposed the new policy just a day before its medical director was due to meet with Londonwide LMC representatives.

The move has triggering anger among GP leaders who warned that the imposition of top down rationing policies are risking patient safety, delaying care and piling workload on GPs.

Dr Tony Grewal, medical director of Londonwide LMCs, and a GP in Hillingdon said: ‘LMCs have been working desperately hard to try and reduce the difficulties that these policies cause – the main ones being a small, but definite, risk to patients, significant risk of additional delay and significant additional workload for GPs in what should be a simple request for advice.’

‘We have bent over backwards to discuss, challenge and to help PCTs in producing these policies, which they are producing under pressure from above. But it makes it very difficult to work cooperatively when what amounts to a slap in the face is delivered in this way.’

Londonwide LMCs is promoting 10 principles for referral rationing, beginning with ‘it is a GP’s professional responsibility to refer to or seek an opinion from a consultant or other clinician’ and ‘a GP must be able to directly refer to secondary care when this is in a GP’s opinion appropriate’.

In its latest newsletter for GPs in North London, Londonwide LMCs said: ‘The implications of the lack of appropriate consultation with the LMC are highly disturbing, not least for any future dealings with the cluster, and this has been made very clear. Londonwide LMCs and the LMC Chairs share the enormous concerns of practices regarding the unilateral imposition of a policy which has such implications for practices and patients without consultation with LMCs.’

Dr Doug Russell, director of primary care for NHS North Central London said: ‘We have an ongoing dialogue with Londonwide LMCs regarding our procedures of low clinical effectivenesspolicy and they have put forward a list of principles for NHS North Central London to review.’

‘It didn’t prove possible to meet with Dr Grewal of the Londonwide LMC until the day after the policy had been distributed. Understandably this caused concern, for which I have written to Dr Grewal to apologise. We will be working more closely with the Londonwide LMC’s as we regard them as very valuable partners.’

The PCTs’ controversial move by comes as NHS London, the strategic health authority that oversees care across the capital, admitted it is considering scrapping low clinical priority lists in favour of a peer-led approach to reviewing referrals. Londonwide LMCs has backed the idea in principal, arguing that ‘exemplar pathways’ model is seen ‘as the way forward.’

Dr Andy Mitchell, Medical Director for NHS London said:‘A change to the wider use of peer-reviewed, evidence-based pathways would be more appropriate and the most effective way of changing clinical behaviour.NHS London has been working with specialty groups to produce exemplar pathways, such as for hip pain.  This work is ongoing and no decisions have been made.’