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GPs struggle with backlog after most referrals were blocked for two months

Exclusive GPs in Liverpool were unable to refer for anything other than urgent cancer over April and May, leading to fears around a backlog of referrals in the coming months, the LMC has said.

Liverpool LMC has told Pulse that two major hospitals – the Royal Liverpool and Aintree University Hospitals – decided early on in the pandemic to only accept two-week wait referrals.

At one point, the option to refer was removed entirely from the directory of services on the e-Referral System, the LMC said.

NHS Liverpool CCG acknowledged there had been concerns raised by GPs, but added that the problems with the e-Referral system had been resolved, and there is greater collaboration between primary and secondary care.

However, the LMC said that there has been a significant knock-on effect due to a backlog of referrals.

At the beginning of the pandemic, NHS England had acknowledged that there would be reduced capacity in secondary care, but said that GPs should continue to refer.

In other areas of the UK, such as London and Birmingham, radiology referrals for suspected cancer in particular have been rejected, but the issue in Liverpool has covered all disease areas, including neurology and dermatology.

Dr Rob Barnett, secretary at Liverpool LMC, told Pulse: ‘The problems in Liverpool started early in the pandemic, in relation to Liverpool University Hospitals NHS Foundation Trust. [They] made a decision to only accept two-week wait referrals. They wanted GPs to hold onto these routine referrals, but it became obvious fairly quickly that GPs were struggling.

‘It was a ludicrous situation where GPs contacted consultants for advice via “advice and guidance” – the consultants had said the GPs needed referral, but during April and May, there was nowhere to make the referral.

‘Any type of referral was affected, such as for neurology, ophthalmology and dermatology. On the whole, two-week wait cancer referrals were okay, but there were problems for those needing endoscopies.’

He said that these problems have been alleviated. However, there were problems going forward, he added: ‘Our worry now is about the backlog of referrals, and another issue we’re contending with is that patients are reluctant to go to hospital, even for surgery, for a fear of getting Covid-19.

‘I want patients to be seen according to clinical need, but worry that it’s taking a long time for them to be seen. The clinical needs in some cases are acute, with some GPs struggling to get patients seen appropriately.’

Dr Fiona Lemmens, chair of NHS Liverpool CCG, told Pulse: ‘Over the past few weeks, local GPs have raised a number of concerns through the LMC, related to difficulty in making routine referrals and pre-existing referrals being sent back to GPs.

‘As a result, the CCG has been liaising with the local NHS Hospital Trusts and GPs are now able to access services via the electronic referral system.

‘The North Mersey CCGs, LMCs and NHS Trusts have reconvened the previous Primary Secondary Care Interface meeting to bring together clinical colleagues to collaborate on recovery plans and communication between organisations.’

Dr Tristan Cope, medical director at Liverpool University Hospitals NHS Foundation Trust, said: ‘As with all hospitals across the country, we significantly re-focused our services to build acute and critical care capacity for seriously ill patients in the face of the biggest health emergency the NHS ever faced and we have continued to accept and undertake urgent activity, including cancer care during this period.’

In March, the month the UK was placed into lockdown and many NHS services began concentrating on Covid-19, GPs collectively made 30% fewer referrals.

Some of this is due to fewer patients coming forward – causing leading GPs such as Dr Nikki Kanani and Professor Martin Marshall to disseminate the ‘NHS is open’ message.