This site is intended for health professionals only

GPs need to be the masters of their own referrals

By Richard Hoey

It’s supposed to be a new era, but PCTs are still trying to block GP referrals on the basis of dubious statistical analyses, says Pulse editor By Richard Hoey

So, hip and knee replacements are not a waste of time. Patients benefit from them, quite a lot actually.

That will hardly be news to most GPs, or indeed most patients.

But it will presumably come as something of a shock to the Office of Health Economics, which has spent the last year deriding these ops as a waste of time and money.

Its analysis had claimed that half of hip and knee replacements were not worth doing, because patients either weren’t suffering significantly impaired quality of life beforehand, or didn’t benefit afterwards.

There was just one problem with this analysis… it was nonsense.

A new study of patient-reported outcome measures (PROMs) satisfyingly debunks the OHE myth, by finding that more than 90% of patients did in fact derive benefits from their operations.

The problem, however, is that PCTs have already been rushing to cut back on access to hit and knee ops, flourishing their OHE papers, and declaring that the procedures are now ‘low clinical priority’.

And while GPs may now win this particular battle, all across the country, trusts are placing management of referrals right at the frontline of their drives for efficiency.

I’ve been told of one PCT, now apparently facing an apocalyptic £51m end-of-year deficit, that is planning to start reviewing every single GP referral – other than those under the two-week rule.

A panel will decide whether a referral should go ahead and, if so, how quickly… with explicit plans to delay activity to the next financial year where possible.

This sort of thing can only become more common as trusts across the country slip badly behind in their efficiency plans.

Unless, that is, the Department of Health decides that draconian referral management is out of kilter with the new GP-led NHS.

There are positive signs – the DH has already made clear it is inappropriate for trusts to clamp down on referrals purely on the basis of PROMs.

The key question is whether it is prepared to go the extra step and rule that referral-management schemes more widely are now inappropriate except when they have the explicit agreement of local GPs.

GPs are supposed to have been placed in charge, these days. They should not have their clinical decisions overruled by the latest managerial committee armed with a sheaf of unreliable stats.

By Richard Hoey, Pulse editor