When did ‘referral' become a dirty word? As described in PCT board minutes, GP referrals are an enemy horde, multiplying inexorably and draining the health service of blood.
QIPP efficiency targets read like war plans, proposing brutal hacks in referrals of 25% or more. It is from that fear and suspicion that referral management centres, and a host of other restrictions on GPs' right to refer, have sprung. Our investigation this week reveals some of the consequences – six-week delays to treatment, errors affecting ‘clinical outcomes', a computer algorithm overriding the decisions of people and patients misinformed about their care.
If GPs are to lead a reappraisal of policies towards referrals, the first step must be a reclaiming of the term. A GP referral represents an assessment of a patient by a highly trained professional, a decision they fall into the minority of cases that cannot be dealt with in primary care, and a considered judgment over which of a wide range of specialties is best placed to take forward their management.
Referring to hospital is a key part of the GP's function as gatekeeper and navigator, and an important stage in the therapeutic process. It should be treated not as a problem, but as a highly valuable – if unfortunately expensive – resource.
Pulse's new campaign – A right to refer – aims to fight back against unthinking restrictions on referrals. It is not intending to rail, King Canute-style, against any attempt to modify GPs' referral behaviour. The NHS is facing unprecedented cost pressures and it is inevitable GP referrals will face increasing scrutiny. But we believe any attempt to control referrals should be implemented with the full involvement and agreement of GPs, and with the sensitivity you would expect whenever costcutting trumps clinical priorities. Board minutes tend not to trumpet reductions in availability of cancer treatment or blood pressure checks – neither should they brag about crude numerical restrictions on the right to refer.
Clinical commissioning groups (CCGs) have an opportunity to adopt a more enlightened approach to referrals than PCTs have, but some are bowing to pressure to continue, or even extend, existing, inflexible policies. Our campaign aims to champion approaches that draw on the expertise and experience of GPs – and expose those imposed on them.
CCGs must have a mandate from GPs – so we are demanding that all those where there is a referral management centre put it to a ballot of practices. If your referrals are being restricted to the detriment of patients, let us know, and we'll work with your local media to apply pressure for a rethink.
We also want the Government to provide funding for GP peer review of referrals, which research suggests is much more effective than top-down managerial approaches. And we are asking for a guarantee from health secretary Andrew Lansley that if a GP believes it is demonstrably in a patient's best interest to be referred to hospital, they have the right to make the referral. It is part of what being a GP is about.
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