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GPs should ‘keep patients away from hospital’, says NHS England



NHS England has encouraged GPs to ‘keep patients away from hospital’, despite recent messages to restart routine care.

In the latest update to the GP standard operating procedures, NHS England said GPs should continue to use specialist advice and guidance ‘where available’ to avoid referring patients for outpatient appointments.

But GP leaders said the guidance is ‘disingenuous’.

Throughout the Covid-19 pandemic, GPs have warned that they are managing more patients ‘outside their comfort zone’ due to less support from secondary care services.

And one LMC last week warned NHS England that its local hospital has ‘closed its doors to patients’.

However, the standard operating procedure reiterated that GPs should ‘continue to refer patients’ to secondary care, basing judgements around urgency on ‘usual clinical thresholds’.

The document said: ‘GPs should continue to use specialist advice and guidance where available to inform the management of patients in primary care and avoid unnecessary outpatient activity. 

‘These services should strengthen existing care pathways and keep patients away from hospital settings unless a referral is necessary.’

It added that they should take into consideration the ‘need for non-face-to-face consultations, likely delays in restarting routine elective activity and communicating likely delays to patients at point of referral’.

Lincolnshire LMC medical secretary Dr Kieran Sharrock told Pulse that the guidance is ‘disingenuous’.

He said: ‘We don’t make referrals just because we feel like doing them – we only make them when we feel they’re necessary.

‘Clearly we have to try and avoid sending patients to hospital where there’s a risk of Covid and so what we should be able to do is make referrals and then the hospital assesses whether or not the patient needs to be seen.’

Dr Sharrock added that not all specialties in Lincolnshire are accepting advice and guidance referrals, while others follow pathways that create delays which could mean the referral ‘doesn’t actually happen’.

He said: ‘For instance, you make a referral for advice and guidance and the advice is ‘refer this patient to see me in outpatients’, which just creates delay for the patient [and] bureaucracy for the GP practice. 

‘We don’t really understand why if a specialist feels they need to see a patient they can’t just refer them directly to their own clinic or make some arrangement to assess them virtually via video consultation or telephone.’

He added: ‘We are warning patients [about delays] but if they then do want us to refer because we can’t manage their condition then what other choice do we have?’

Since April, NHS England has told GPs to continue referring patients to secondary care despite restrictions on elective care due to Covid-19.

Last month, it outlined that trusts must make their e-referrals service ‘fully open’ to GPs.

But an audit by the Royal College of Physicians revealed some specialties could take up to two years to clear their referral backlog – following similar concerns raised by GPs in Liverpool.

Meanwhile, health secretary Matt Hancock this month signalled that he wants GPs to continue to consult patients who would typically be seen in secondary care – with specialist help – after the Covid-19 pandemic comes to an end.

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