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Remove referral decisions from GPs ‘to avoid conflicts of interest’



NHS England has recommended the wider rollout of third party referral management to reduce the risk of GPs being accused of conflict of interest, in a move described by GP leaders as ‘especially perverse’.

The recommendation contained in guidance released by NHS England last month, recommends a ‘third party’ is used to manage referrals as part of a number of ‘good governance processes’ where GPs have an interest in a provider service that the patient could potentially choose.

The document, Managing conflicts of interests: Guidance for clinical commissioning groups, said in its recommendations to commissioners: 

‘There are a number of current good governance processes to ensure patients are being given appropriate choice, particularly where referring GPs have an interest in a provider service that the patient could potentially choose.’

It goes on to say: ‘Establishing referral management systems – There could be systems whereby, once a GP has made a decision to refer, a third party manages the discussion with the patient about which service they wish to be referred to. This would take away any perceived potential for GPs to influence patient behaviour.’

Dr Laurence Buckman, chair of GPC, said while GPs understood the use of referral management to save money, to recommend them to reduce conflicts of interest was a new suggestion.

He said: ‘The usual reason is that we want to save money, and that is honest. We accept that, even if we don’t like it. But to do so on the basis that we are conflicted, that seems to be especially perverse.’

Dr Chaand Nagpaul, a GPC negotiatior, said: ‘The Government’s guidance was suggesting that the decision about where a patient should refer to should not rest with GPs, but that a third party referral management centre should have that dialogue with patients to remove any conflicts of interest. This sort of suggestion is at odds with the doctor-patient relationship.’

But Ben Dyson, director of commissioning policy and primary care at NHS England, said: CCGs have a duty to manage any actual or perceived conflicts of interests. NHS England’s guidance on managing conflicts of interest suggests where GP practices are one of a number of providers to which patients can choose to be referred, CCGs may wish to consider systems that allow a third party to discuss with the patient which of these service they wish to be referred to.

‘This does not constitute a recommendation to roll out referral management centres. It is just one example of how CCGs could choose to manage conflicts of interest.’