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GPs should continue to refer patients to secondary care, says NHS England

NHS England has said GPs should continue referring patients to secondary care despite current restrictions on elective care due to Covid-19.

It said guidance will shortly be published advising that secondary care ‘accept and hold clinical responsibility for GP referrals’.

This comes as NHS England told hospital trusts on 17 March that they ‘should assume’ they would ‘need to postpone all non-urgent elective operations from 15 April at the latest, for a period of at least three months’.

But in a bulletin to GP practices, sent yesterday evening, NHS England said: ‘NHS guidance will be published shortly advising secondary care to accept and hold clinical responsibility for GP referrals.

‘Therefore, GPs should continue to refer patients to secondary care using the usual pathways and to base judgments around urgency of need on usual clinical thresholds (taking into consideration need for non face to face consultations, likely delays in recommencement of routine elective activity, and communicating likely delays to patients at point of referral).’

It added that GPs should take advice from specialists ‘where available’ in the instances when they need to manage the care of patients who are awaiting secondary care review.

‘GPs should continue to use specialist advice and guidance where available to inform management of patients whose care remains within primary care including those who are awaiting review in secondary care when appropriate,’ the bulletin said.

Specialists would be told to advise GPs ‘in a timely fashion’, NHS England added.

It said: ‘Colleagues should work collaboratively across primary and secondary care to ensure this advice and guidance is provided in a timely fashion to ensure safe care is delivered, taking into account the exceptional pressures which exist across the whole system.’

The bulletin added that ‘partners at a local level’ need to agree ‘clear, consistent processes exist to ensure safe handling of emergent, urgent and routine referrals from primary care’.

But, as it stands, not all GPs are able to refer as usual.

Speaking in a live webinar yesterday evening, NHS England primary care medical director Dr Nikita Kanani said: ‘On referrals, I know that some areas are getting bounce backs or being told that they can’t [refer].

‘This will be a clearer direction to the system on what we’re doing with referrals.’

An NHS Digital spokesperson told Pulse: ‘The NHS e-Referral Service (e-RS) is operating as usual for GPs to use to make referrals to secondary care.

‘Guidance will be published shortly advising that GPs should continue to make referrals where clinically necessary, through e-RS, and it will include further advice on how e-RS can be used to support referrals in the current circumstances.’

The news comes as Pulse has launched its Clinical Crises series, which has simple, short guides for GPs written by specialists and GPwSIs explaining what GPs should do when faced with presentations that would usually be managed in secondary care.