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GPs told to refer patients ‘out of county’ for four specialties due to staff shortages

GPs in Lincolnshire have been told to refer patients out of county for some specialist treatments due to a shortage of specialist doctors and long waiting lists.

The United Lincolnshire Hospitals Trust (ULHT), which is in special measures, has told GPs in the area to consider alternative providers outside of the county for non-urgent ear nose and throat (ENT), cardiology, neurology and dermatology services.

This situation has been continuing for two months, and the trust says it is offering GPs an ’advice and guidance service’ with a cardiology consultant to receive advice on the best treatment for the patient’.

It follows a similar situation in Adenbrooke’s Hospital in Cambridge, which last month asked GPs to refer patients to the community urgent care support team ‘whenever possible’.

The BMA’s GP Committee said that patients having to travel far distances due to financial pressures was a ‘concern’, and would make life harder for patients and GPs.

ULHT has said that it has struggled to recruit staff in certain specialties and is still treating urgent cases.

Deputy director of operations at ULHT Neil Ellis said:’The cardiology, ENT, dermatology and neurology services within Lincolnshire’s hospitals are under significant pressure in some cases long waits are being experienced. As part of our continuing quality improvement programme we are working with NHS Lincolnshire East CCG to ensure patients are able to access services from other providers outside of Lincolnshire.

‘The Trust continues to offer an advice and guidance service where GPs are able to discuss possible referrals with a cardiology consultant and receive advice on the best treatment for the patient. We are committed to resuming a full service as soon as possible.’

Dr Richard Vautrey, chair of the GPC, said that patients travelling longer distances to get the right care was often ‘necessary and appropriate’. However, he added: ‘If it is for more routine secondary care and simply because of financial issues it will be a concern for GPs and particularly for patients and their families.

‘It can make it difficult for GPs to develop a good relationship with specialist colleagues and there is a risk that this leads to unplanned and unfunded workload shift on to the local GP service. It’s also very difficult for patients who are admitted to hospital a significant distance from their home as it makes it hard for friends and family to visit or for the hospital team to know what local community support will be available when discharge is planned.’

Dr Keiran Sharrock, medical director of Lincolnshire LMC, said: ‘The LMC understands the challenges faced by ULHT in recruiting staff, as general practices face similar challenges, and we support the principle of not accepting new referrals if it is not safe to do so.

‘We feel that it is the role of the commissioners to support general practice to be able to find alternative providers who can safely and locally provide patients with appointments. This is not a failing though of either the provider, or commissioner, but is a symptom of the underlying malaise within the NHS caused by a decade of underfunding.’

ULHT is the latest hospital trust to ask GPs to stop referring patients due to capacity issues, after Addenbrooke’s sent a letter to GPs warning its medical decisions unit was ‘currently full and there are patients within the emergency department awaiting admission that cannot be placed into inpatient beds due to a lack of bed capacity’.

Meanwhile, patients faced waits of up to 13 hours to be seen at the A&E department at Queen Elizabeth The Queen Mother Hospital in Margate.

Pulse has previously reported that the BMA has declared the winter crisis a ‘year-round norm’ with an analysis that shows that trusts’ performance this winter hit record lows, despite mild weather and no major flu or norovirus outbreaks

Doctors voted at this year’s BMA Annual Representitive Meeting that GP practices should also be able to declare ‘black alerts’ when their surgeries are at maximum capacity, the same way that hospitals do.

This comes as NHS England statistics reveal that the percentage of A&E attendances admitted to hospital or discharged in four hours or less fell from 87.9% in 2015/16 to 83.7% in 2016/17 in hospital trusts with major A&E departments.

Nationally, major A&Es have missed the target every year since 2010 when 96.1% of patients were admitted or discharged within four hours.