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Hospitals axe 1.2m follow-up appointments in a year

Exclusive GPs are being dumped with a huge wave of work from secondary care after hospitals cut back the number of follow-up appointments they carried out by more than a million last financial year, a Pulse investigation reveals.

An analysis of data from all 168 acute hospital trusts in England reveals the ratio of follow-up appointments to surgical procedures has plummeted by 4.3% in the last year, and 5.9% over the last two years, as managers impose a series of brutal efficiencies.

Based on last year’s total of 10.1 million operations in the NHS, there are calculated to be 22.2 million follow-up appointments – 1.2 million fewer than would have been expected based on 2009/10 rates, and 1.6 million fewer than under 2008/9 rates.

In 2008/9 the so-called ‘new to follow-up ratio’ was 2.36, but by 2009/10 it had dropped to 2.32 and it plummeted in 2010/11 to just 2.22. The overall drop included steep falls at Pennine Acute Hospitals NHS Trust, where the ratio dropped from 2.87 in 2008/9 to 1.78 in 2010/11, and at Ealing Hospital NHS Trust, where it fell from 2.51 to 1.84.

Pulse’s analysis of the data, provided by the NHS Institute for Innovation and Improvement, came as one LMC warned its PCT was sharply cutting funding for follow-up appointments at local hospitals this financial year.

Gloucestershire LMC reported that NHS Gloucestershire was reducing by an across-the-board percentage the number of follow-up appointments it was prepared to commission.

An LMC meeting last month heard 900 rheumatology follow-ups would be cut, with dermatology, urology and other departments also affected. The LMC said it was ‘concerned patients with chronic conditions could be prejudiced by being discharged to GP practices where there might be neither the skill nor the capacity to treat them’.

Dr Philip Fielding, chair of Gloucestershire LMC, said: ‘This is another of the games hospitals play to save money. Readmissions are obviously a concern because they are more expensive than follow-up appointments. Everything has workload implications for primary care at the moment. There comes a time when enough is enough.’

NHS Gloucestershire refused to say by what percentage it had cut funding for follow-ups, but locality commissioning director Mark Walkingshaw said: ‘We work with acute providers and GP commissioners to, where it is appropriate to do so, reduce the  number of follow-up outpatient appointments.’

A Department of Health spokesperson said: ‘All patients with a clinical need for a follow-up appointment in hospital should have one. We have not set targets to reduce the number of follow-up appointments and have no plans to do this.’

Dr Michelle Drage, chief executive of Londonwide LMCs, said: ‘It’s part of a whole range of things hospitals are up to to save money. As a result, patients get poor continuity of care.’