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Revealed: Two-week referral breaches, rejected referrals and worsened patient outcomes


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Exclusive GPs are seeing a significant increase in the number of referrals being rejected or bounced back as well as breaches of the two-week wait cancer referral times, a major Pulse survey has revealed.

The survey of 761 GPs in England – taken in conjunction with ITV’s Good Morning Britain –  found that they are seeing urgent cancer referrals exceed two weeks nine times a year on average.

Meanwhile, well over half have seen a ‘significant increase’ in referrals being rejected by secondary care, while almost all say patient outcomes are suffering as a result of long waiting lists.

The Government has warned the waiting list, already at more than 6 million, is likely to continue growing for the next two years.

Respondents to the Pulse survey said they were seeing ‘hugely increased’ consultations from patients waiting for care which impacts on access for others and said that frustrated and anxious patients were becoming angry with GP staff.

Among 761 GPs who responded to questions on waiting times and referrals:

  • On average, the two-week wait for urgent cancer referrals is being exceeded nine times a year
  • 93% said the elective care waiting lists have worsened outcomes for patients with two in three believing they have ‘significantly worsened’
  • 85% say there has been an increase in referrals to secondary care being rejected or bounced back – including 58.5% saying a ‘significant increase’
  • Only 1.5% of respondents said they haven’t affected patient outcomes negatively.

Dr Lizzie Toberty a GP in Newcastle who responded to the survey said they were now seeing two-week referral patients being triaged – something that was unthinkable before the pandemic.

She told Pulse: ‘There are clearly huge pressures on resources in hospital but we have to recognise the anxiety that patients are having which then results in extra appointments with the GP.’

Dr Toberty, who is also a spokesperson for the Doctors’ Association UK, said whenever long waiting lists are reported it is those waiting for a hip or knee replacement who are highlighted.

But she is particularly worried about those with complex mental health problems including eating disorders who are falling between the cracks.

She said: ‘These are patients with complex needs and the waits for them to get a definitive diagnosis or treatment are really long and the referral pathways are not clear.

‘It all lands on the GP and it’s hugely stressful. Decisions around their care should be being made by a team of people. You get to the point where you think there’s no point referring them.’

One respondent to the survey had said they were particularly concerned about delays for patients with suspected breast cancer.

Dr Monika Blackwell, a GP in South Gloucestershire, said the local advice and guidance system is helpful but workload for GPs had increased in relation to referrals and she is particularly concerned about waiting times for breast cancer referrals.

‘Even today I am waiting on results from a scan done under a two-week wait referral at the beginning of February and have not had a reply’, she told Pulse.

The latest provisional data from December showed 78.6% of people were seen by a specialist within two weeks of an urgent referral for suspected cancer and 50.9% of people urgently referred for breast symptoms (where cancer was not initially suspected) were seen within a fortnight.

Dr Jane Wilcock, a GP in Salford, said just today she had received referrals back from dermatology and ENT.

‘Letters from secondary care and X-ray results are taking longer so there is a middle couple of weeks where people are contacting general practices and information isn’t available, as it used to be.’

She added that perhaps patients should be given a more accurate picture of what to expect in secondary care people understand that everyone is under pressure.

‘There is no doubt pathways for people are delayed and occasionally rebuffed due to the extraordinary stress secondary care is under.’

Under the Government elective recovery plan to tackle NHS backlogs, GPs will be expected to make greater use of advice and guidance systems rather than referring patients for investigation.

A portal was launched this month to help patients get more information on waiting times locally.

RCGP chair Professor Martin Marshall, said the whole NHS was stretched beyond its limits and colleagues were working incredibly hard.

‘But it’s important to recognise that GPs will only make referrals if they think they are appropriate and in the best interests of their patients.

‘We want patients to have as smooth a referral process as possible, and a ‘back and forth’ scenario is both frustrating and worrying for patients, and increases workload across the board.’

Results in full

To what extent has there been an increase or decrease in referrals to secondary care being bounced back or refused since pre-pandemic?
Significant increase 58.48% 445
Slight increase 26.54% 202
Neither increase nor decrease 8.54% 65
Slight decrease 0.39% 3
Significant decrease 0.66% 5
Don’t know 5.39% 41
  Answered 761

How often do you find urgent cancer referrals exceed two weeks?
Never 8.94% 68
1-2 times a year 13.01% 99
3-5 times a year 16.43% 125
6-10 times a year 14.32% 109
11-15 times a year 8.02% 61
16-20 times a year 4.73% 36
21-30 times a year 3.81% 29
More than 30 times a year (please specify in comments box) 4.73% 36
Don’t know 26.02% 198
  Answered 761

What impact has the increase in secondary care elective waiting times had on patient outcomes?
Significantly worsened patient outcomes 65.97% 502
Slightly worsened patient outcomes 26.81% 204
Had little or no impact on patient outcomes 1.45% 11
Don’t know 5.78% 44
  Answered 761

READERS' COMMENTS [5]

David Banner 4 March, 2022 9:57 am

All of Secondary Care are following the path bravely beaten by CAMHS. Can’t manage your referrals properly? Simple! Just bounce them all back to the GP! Now you can proudly boast of meeting all your waiting time targets, and dodged all responsibility which has cleverly been dumped back on the hapless GP. Et voilà, all your capacity problems disappear. Many thought CAMHS couldn’t possibly get away with such blatant outrages, but instead their model is being eagerly replicated across all other departments. It’s evil genius when you think about it…. Bravo!!

David Church 4 March, 2022 1:54 pm

I was not sure this was ‘news’, as it isn;t really ‘new’, but maybe confirmation of the extent of it is…..

Patrufini Duffy 4 March, 2022 2:11 pm

Hospitals get 90% of the budget and all the gizmos. They will survive. And all their Consultants are doing good NHS overflow private work. Get over it. As Javid doesn’t need mindful GPs anymore – watch your referral rates increase, with the odd red flag or two. You can’t reject that ICS.

Slobber Dog 5 March, 2022 11:01 am

Triage of 2 week wait referrals?
Why not so long as the solicitor’s letter doesn’t fall on my doormat.

Nicholas Sharvill 5 March, 2022 5:42 pm

once hospitals return to payment by activity this may change- assuming the political will is there. We saw though in the pandemic all trust debts were just wiped out overnight so seems little incentive to ”earn money’ ? bring back fundholding..why is NHSE not trailing this I wonder