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London GPs told to cut back out-of-area hospital referrals

A group of CCGs has told local GPs to restrict out-of-area referrals as part of new measures to reduce costs.

North West London Collaboration of CCGs (NWLCCCG), which comprises eight commissioning groups, is developing a ‘financial recovery plan’ in a bid to cut its healthcare overspend.

Under the proposals, GPs have been urged to refer patients to North West London services, instead of sending them to out of area services, with the aim of cutting out-of-area referrals by 15%.

The CCGs said referring and treating patients within the area would save 30% on tariff costs.

In addition, the CCGs wants to bring down the number of GP referrals for acute treatment by finding alternative ways of dealing with patients’ needs. 

GPs and local councillors fear the financially driven measures will have a detrimental impact on patient care.

In a letter sent to local partners and stakeholders last month, NWLCCCG outlined plans to address its £112m deficit forecast in 2019/20, which was previously estimated to reach only £51m.

The measures include:

  • Repatriation of 15% of elective work referred out of sector back to acute providers;
  • Significantly reducing consultant to consultant referrals, follow ups and outpatient procedures;
  • Reducing the £18m spent on over-the-counter medicines.

The letter stated: ‘All parts of the NHS in North West London are working together with local people to develop a long term strategy that improves health and care and ensures robust, high quality services for all our patients. That strategy will be our local response to the NHS Long Term Plan. We expect to publish the final version of our local five year strategy in November 2019; a draft will be circulated in September 2019.

‘At the same time, we face an immediate challenge, with our sector as a whole forecasting a significant financial shortfall this year. As such, alongside our longer-term planning, we are developing a financial recovery plan to get us back on track, so that we can focus on the improvements we need to make for the future.’

The CCG said it will look at acute contracts held by primary care networks and practices to address any excessive acute treatment activity. 

A spokesperson for NWLCCCG said: ‘We want to work with GPs to understand why growth is in excess of contract and understand whether there are other alternative ways of dealing with the patient’s needs. There are big differences in between practices in terms of referral rates, so this will be an opportunity to share learning and best practice across all eight boroughs in North West London.’

On referrals, they said: ‘We will not restrict referrals between specialties within agreed pathways, and nor will we do so in case where patients require an urgent opinion. However, we do need to work out why there has been such apparent unplanned growth, make sure the coding is correct and stop inappropriate referrals.

‘All outpatient specialties will continue to deliver follow-up care and procedures. For some patients this might be best provided by a community service or via a telephone appointment. The right follow-on care and advice does not always need to be provided by a consultant at a hospital.’

BMA London regional council chair and London GP Dr Gary Marlowe is concerned by the lack of GP input in the CCGs’ decisions, warning these should not be done to the detriment of patient care or increase workload. 

He said: ‘We appreciate that all CCGs are dealing with intense financial pressure, and it’s only right that commissioners look at inefficiencies and areas of wastage to ensure that their funds are being used appropriately, responsibly and to ensure the best for patients.

‘Meanwhile, if too many patients are attending A&E then the CCG is right to ask questions about what other options are available – though much of this well depend on a well-functioning and well-funded primary care system locally.

‘However, cost-cutting must not come at the expense of quality patient care or increased bureaucracy and workload for doctors.’

He added: ‘All clinicians – whether in GP practices or in hospitals – must be able to make decisions over what is best for the patient in front of them, based on their own clinical evidence base, and not be blocked by arbitrary money-saving restrictions.’

Labour MP for Hammersmith Andrew Slaughter said: ‘GPs are being told not to refer patients to consultants unless absolutely necessary and then only to those at the local hospital trust where waiting times could run to six months or more.

‘The restrictions on consultant to consultant referrals will hit those with the most complex and difficult conditions hardest. This attacks the whole basis on which the NHS operates and gives the lie to Boris Johnson’s claims of support.’