An investigation by the British Medical Journal, reported in The Times last week, has revealed that, of the 184 clinical commissioning groups in England who responded to their request for information, 39% acknowledged that they employ referral management schemes to screen GP referrals to hospitals.
The centres can block or redirect GP referrals for procedures such as hip and knee replacements, treatment for allergies and cataract surgery to manage outpatient activity at local hospitals. In some areas this has led to a rejection of 1 in 12 referrals and it has been suggested that this could lead to a delay in the diagnosis process.
Although the reason for this monitoring programme appears to be a desperate attempt to save money – with 69% of clinical commissioning groups having collectively spent £57 million in this way since April 2013 – only 14% could show that the scheme had actually saved them money.
Contrary to claims by Graham Jackson, co-chairman of NHS clinical commissioners, that these referral management schemes provide a “useful and effective role”, Dr Richard Vautrey, deputy chairman of the British Medical Association GP committee, commented that it was a “short-term fix to try to cut costs in a cash strapped NHS….that potentially undermines the GP – patient relationship” leading patients to believe “often rightly….that they won’t get the treatment their GP has recommended.”
Professor Helen Stokes-Lampard, Chair of the Royal College of GPs commented that referral management schemes should be “properly evaluated and assessed to see if they will be effective, safe and ultimately benefit the care provided to patients.”
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