Exclusive Confidentiality is being compromised by overbearing referral management procedures with some patients ‘easily identifiable’ from their records, say GP leaders.
At Pulse’s roundtable discussion on the NHS reforms last week, both BMA and RCGP leaders said they were concerned that patient details were being widely discussed without their consent.
Dr Helena McKeown, a member of BMA and the RCGP council, told the rest of the panel:
‘Does your patient expect their referral to be discussed, not only across the practice, but across a large group of doctors who may include some nurses and managers? Were they asked about that?’
‘Some of my patients have been in an unfortunate enough position to have had very expensive hospital stays or procedures. Everybody in my community knows about them. They are easily identifiable.’
During a vigorous debate, RCGP chair Dr Clare Gerada also said she was worried that patient confidentiality was being undermined.
She said: ‘Very little is based around inappropriateness. You can have extremes, and that is a clinical governance issue which should be picked up within the practice or within the PCT.’
‘The idea my referral for my hysterectomy will be discussed with a group of doctors, nurses and managers without my consent… and if you say it is anonymous, I dispute that because actually within a small community, you will know.’
Dr Michael Dixon, chair of the NHS Alliance, defended the use of peer review at both practice- and clinical commissioning group-level.
He said: ‘We spend half an hour every morning looking at referrals in the practice, and often obviate them by doing an X-ray or referring to another partner, and giving the patient a better service so they don’t have to wait for ages to go to outpatients.’
‘The retrospective approach, I think, can be useful too. We do it at our own CCG. We spent a Thursday afternoon two weeks ago looking at referrals of all the GPs in the CCG, and there were a number of variations.’
‘They’re all anonymous. The whole point is, that, there were enormous variations and some of the GPs were using far more resources than others. Unless you grab that bull by the horns, you end up with an NHS that’s not only unequal but you can’t actually pay for.’
Dr Richard Vautrey, GPC deputy chair, added: ‘I would be amazed if any CCGs were discussing individual cases of patients. What most groups would be doing is looking at referral statistics and not at individual cases. If they are, I would be extremely concerned.’