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Serious incidents and patient care blunders at referral gateways under investigation

Exclusive A series of ‘serious untoward incidents’ involving triage of GP referrals at referral management centres has been placed under investigation, Pulse can reveal.

Our investigation across 85 PCTs shows four new referral management centres have been set up over the last year and that many existing gateways are screening a rapidly increasing proportion of referrals from GPs.

But some centres have been dogged with administrative errors and as many as 10 complaints a month from patients and GPs, while three have suffered serious untoward incidents – defined as having potential to cause serious harm to patients.

We expose the incidents – involving delayed operations, patients wrongly diverted by referral management software and decisions affecting a patient’s ‘clinical outcomes’ – as we launch a new campaign demanding respect for GPs’ clinical freedom.

A right to refer is calling for all clinical commissioning groups where there is a referral gateway to hold a ballot of practices on whether it should continue.

It also calls for funding for GP peer review of referrals and the secretary of state to guarantee GPs’ ultimate right to make a referral. We also want a

Department of Health investigation into the serious incidents.

Just over one in four PCTs now has a referral management centre. The degree to which they have been accepted by local GPs and patients varies widely, with an average of 5.2 complaints over the last year, but more than 60 in six months at one centre.

Problems included communication failures, patient complaints about being bounced back to GPs, and letters being sent to wrong addresses or with wrong details about appointments.

NHS North Central London reviewed a gateway for dermatology, rheumatology and ENT referrals after ‘inadequate administration’ led to a serious incident where patients faced delays of up to six weeks for treatment. It said: ‘No patient came to direct clinical harm. We wrote to every patient apologising for the delay.’

In Ealing, west London, a serious incident was recorded after a GP complained referral management software was not following the correct pathway for patient treatments. A spokesperson for NHS Ealing said: ‘Since this SI we have made a number of changes to improve processes. This includes stronger management supervision, additional training for staff and more clinical leadership.’

South East Essex gateway, run by private provider Fortis Healthcare, has been running for less than a year, but has screened 32,000 referrals and recorded 64 complaints and one serious untoward incident since April 2011.

NHS South East Essex said it was investigating an incident relating to a patient’s ‘clinical outcomes’, but would not provide details. Its policy includes incidents that ‘cause death or serious injury’ or ‘contribute to sustained reduction in standards’. Its spokesperson said: ‘Learning will be identified and shared as appropriate.’



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Dr Helen Angel, a GP in Basildon, Essex, said: ‘We have had a lot of problems with the referral management centre. It is constantly sending back referrals for more information, delays things going through and cancels appointments at short notice.’

In the last 12 months, gateways have also been introduced by NHS Bristol, NHS Heywood, Middleton and Rochdale and NHS Coventry. Five of seven areas providing data showed an increase in the proportion of GP referrals being screened in the last two years.

A centre in Hounslow, north London, run by private provider UnitedHealth UK, now channels around 85% of GP referrals, compared with 50% in 2009/10. NHS Heywood Middleton and Rochdale’s service handled 55% in January, but 91% currently.

Dr Richard Vautrey, GPC deputy chair, said it was ‘very concerned’ about referral management centres: ‘They are disempowering clinicians and putting a barrier between referrer and consultant. Serious untoward incidents were always likely. GPs should be fully aware of the risks.’