By Christian Duffin
Exclusive NHS London has launched an SHA-wide review of the capital’s referral management centres, amid mounting concerns across the country over their cost, impact on GPs’ clinical autonomy and the potential for some to be compromised by conflict of interest.
SHA managers have opened talks with Londonwide LMCs to ‘scope out’ possible alternatives to using referral management centres, which have been increasingly relied upon by PCTs to curb rising referral rates but which will shortly become the responsibility of clinical commissioning groups (CCGs).
The move comes as it emerged that a major referral management centre just outside the capital run by Epsom Downs Integrated Care Services (EDICS) is to be split from the organisation’s provider function because of concerns over a possible conflict of interest.
Referral management centres are used across London to triage GP referrals for a range of specialities including dermatology, musculoskeletal medicine and gynaecology, while Pulse revealed in February that NHS Harrow had brought in a ‘total referral management system’ in three GP practices, after other forms of referral restrictions were found to have ‘failed to deliver expected savings’.
But Dr Michelle Drage, chief executive of Londonwide LMCs, said the principal driver of the current talks on referral management was the cost of triage, which a recent report by the King’s Fund estimated at £23 per referral.
‘We have great concerns about the cost of referral management centres,’ she said. ‘Londonwide LMCs would suggest that commissioning should be peer-led. We are currently scoping out ideas with NHS London, and will publish details when we are in a position to.’
An NHS London spokesperson said: ‘Referral management is done at an entirely local level. We are looking at how referral management is carried out across the capital.’
‘We are working to understand what is effective in different areas at the moment and whether any best practice could be shared London-wide. Managing referral patterns is an important challenge for clusters and emerging CCGs as part of QIPP plans.’
Meanwhile in Surrey, EDICS – an organisation which provides about 20 clinics in the community and also operates a referral gateway across four PCTs – has revealed it is to divide its provider and triaging arms to sidestep concerns over possible conflicts of interest.
Dr Peter Stott, EDICS medical director and a GP in Tadworth, Surrey, said: ‘We started six or seven years ago on a provider basis and we are operating within the contract that we were given historically.’
‘But now the agenda has changed. Commissioning and conflicts of interest are becoming important.’
Dr Richard Van Mellaerts, a GP in Kingston-upon-Thames, said he would be glad to see referral management centres go. ‘I see no evidence at all that they drive down costs, and there’s a total lack of accountability.’
‘Most of us are happy to look at ways of managing referrals and costs, but with individual accountability, rather than a third party deciding.’
How referral management works in Bromley, south-east London
• Centre set up in 2009 and run by the PCT
• For 2011/12, the centre only handles referrals made via Choose and Book along pathways where clinical assessment and intermediate services have been developed
• Pathways covered include musculoskeletal services (adult physiotherapy, trauma, orthopaedics and rheumatology), gynaecology and dermatology
• About 80% of GPs’ musculoskeletal referrals are triaged through the centre