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Hospital has ‘closed its doors’ to patients, LMC warns NHS England

GP leaders have written to NHS England to demand that an NHS hospital trust urgently restores routine referrals as it has ‘closed its doors’ to some patients, ‘destabilising’ practices in the process. 

Oxfordshire LMC said local GPs are ‘concerned and angry’ about the ‘ongoing closure’ to routine referrals across multiple ‘high-demand’ specialties by Oxford University Hospital Foundation Trust, while warning GPs are also being asked to carry out tests that should be done in hospital.

A ‘significant’ number of specialties are affected, including ENT, general gynaecology, dermatology, ophthalmology, endoscopy and urology, as well as plastics and maxillofacial, it added.

The hospital trust said it had remained open for urgent and emergency care and was accepting clinically urgent and suspected cancer referrals, while reinstating services to support ‘the vast majority’ of routine referrals.

In April, NHS England 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 Oxfordshire LMC has this week written to NHS England and the council of governors at OUHFT to demand that there are ‘no further delays’ in restoring the services amid concerns of ‘patient harm’.

It said: ‘The LMC believes the continuing closure of some specialty services to routine referrals is now so serious for patients that it has taken a decision to formally raise the concerns of Oxfordshire’s GPs with NHS England.’ 

Oxon LMC chair Dr Raman Nijjar added that GPs are being asked to carry out tests that ‘should be done in hospital’ and are ‘unable to progress a patient’s care in the way they wish’ because services remain closed.

He said: ‘The reopening of these services for routine referrals is now urgently needed. 

‘This disturbing situation at Oxford University Hospitals must not continue as it’s causing anxiety to patients and also having a deeply destabilising effect on local doctors’ surgeries.’

Joint chief executive of the regional LMCs Dr Matt Mayer added that the trust’s position ‘appears to be at odds with the national picture, which sees most hospitals again accepting all routine patient referrals’.

The LMC added that it is ‘understandable and a necessity’ that hospitals have had to focus on urgent unplanned care due to the coronavirus pandemic.

‘But our biggest local hospital cannot effectively close its doors on some of its patients for many months and give up on some of its healthcare duties in this respect,’ it said.

In a joint statement from OUHT and Oxfordshire CCG, the organisations said: ‘Throughout the pandemic, OUH was able to treat Covid-19 patients by asking staff to move from their normal activities to support affected patients. OUH remained open for emergency and urgent care, but in line with the rest of the UK routine and elective procedures were stopped.

‘During Covid-19, OUH continued to accept clinically urgent and suspected cancer referrals from GPs, and continued to carry out urgent and emergency treatment.

‘OUH is now able to reinstate services to support the vast majority of routine referrals, including plastic surgery and urology. GPs can continue to make routine referrals across all specialties, but some areas in high demand will see patients seen and treated outside of OUH.’

They added: ‘Patient and staff safety is an absolute priority for us, and we need to reinstate services in a safe and effective way.’

It comes as 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.

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

Last month, 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.

And GP leaders warned that hospitals rendered ‘untouchable’ by coronavirus measures were still rejecting around 75% of referrals and ‘reverse delegating’ patients back to their GPs.

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.

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