Primary care minister refuses to rule out non-doctors rejecting GP referrals

A shadow health minister has raised concerns in Parliament over non-doctors rejecting hospital referrals and ‘massaging’ of waiting lists.

This came as the primary care minister refused to confirm whether only consultants will be able to divert GP referrals to advice and guidance under this year’s contract.

During a debate in the House of Commons, Stephen Kinnock refused to answer a question by shadow health minister Dr Luke Evans on whether GP referrals will be ‘reviewed explicitly by a specialist consultant before being rejected or redirected’.

Dr Evans, who is a GP, told the House that referrals and A&G requests ‘could potentially be assessed by a non-doctor’, under ‘Government pressure’, due to the Government aiming for 25% of GP referrals to be ‘diverted’ back.

Under changes to the GP contract for this financial year, GP practices are contractually required to use A&G across specialities ‘prior to or in place of a planned care referral where clinically appropriate’, with ‘single point of access’ routes to be finalised locally by 1 October.

And NHS England guidance, seen by Pulse and marked as ‘sensitive’, said that A&G will be ‘consultant-led, multi-professionally delivered clinical review of general practice enquiries and referrals’, which has left some GPs concerned non-doctors could be asked to review and respond to requests.

Dr Evans, who is the Conservative MP for Hinckley and Bosworth, said: ‘Under the Labour Government’s new GP contract, all GPs will have to refer through a single point of access.

‘Can the minister confirm that every referral deemed clinically necessary by a GP will be reviewed explicitly by a specialist consultant before being rejected or redirected?’

Mr Kinnock said that he was ‘astonished’ that the Conservatives ‘seem to be teaming up with the British Medical Association’ in opposition to Labour reforms.

It comes as the BMA’s GP committee is threatening GP collective action from 30 April unless the Government ‘pauses’ its plans around mandated A&G.

The doctors’ union is also currently seeking legal advice on the new requirements, amid fears it removes GPs’ right to refer.

Mr Kinnock said: ‘[The Conservatives] ought to listen to their voters and their members, who are crying out for change. We are getting the NHS to do things differently because that is the only way we are going to turn it around.

‘Advice and Guidance is seeing more investment in GPs and getting patients cared for in the right place at the right time.’

Dr Evans said that the House ‘will have heard that there was not an answer’.

He added: ‘That was a no. It is plain for all to see that this means patients will be blocked from seeing a specialist.

‘They could potentially be assessed by a non-doctor, under Government pressure, with a target of one in four referrals being bounced.

‘The Government’s own answers show that patients never appear on a waiting list. This is not about improving healthcare; it is about massaging the waiting lists, isn’t it, minister?’

Mr Kinnock said: ‘I have honestly never heard so much nonsense in my entire life. We invested £80m in Advice and Guidance. Some 1.1 million Advice and Guidance requests were diverted from the waiting list, so that care is being delivered in the right place.

‘We have embedded A&G into the core contract, recognising it as routine practice, removing annual sign-ups and providing more predictable funding.

‘The shadow minister seems to be saying that patients who do not need to be treated in hospital should be treated in hospital. That runs completely counter to the entire strategy, which is about moving care from hospital into the community. The Conservative Party needs to get with the programme.’

Funding for A&G has been moved into the core contract, with the item of service fee being scrapped. The move formalises a trajectory of NHSE moving towards A&G becoming the norm rather than traditional referrals – with the rollout having started in earnest in 2022, when NHSE said it should be the main referral pathway for access to dermatology services.

Last month, a group of LMCs urged GPs nationwide to challenge any mandated use of A&G, amid concerns that it could introduce safety risks for patients.