‘We are not against improving patient referral standards, but we are opposed to referral management to cut costs and ration treatment,’ British Medical Association GP Committee chairman Dr Hamish Meldrum told a BMA press conference yesterday.
Referral Management Schemes which intervene in the patient’s care pathway from GP to hospital treatment, are being introduced throughout the country.
Dr Meldrum commented: ‘In some areas we would consider them mis-management.’
He added: ‘Models vary across the country, but diverting GP to Consultant referrals to a referral management centre seems to be increasingly common.
‘The Centre then decides what happens to the patient’s care.
‘Where local clinicians have been consulted and involved in designing the schemes, things may be working well.
‘In other places there has been no effective consultation and it seems the main intention is to cut costs either by trying to limit referrals or by delaying them.
‘NHS Trusts are telling GPs that non-urgent cases will not be treated until they have reached the maximum waiting time permitted within government targets.
‘This is not acceptable and is potentially harmful to patients’ health.’
Dr Meldrum was asked how the new scheme affected the government’s waiting time targets.
He said Primary Care Trusts (PCTs) were delaying referrals ‘up to the twelfth week’ of the government’s thirteen weeks referral target to delay having to pay for treatment.
Asked who took the referral decision under the new scheme, Dr Meldrum said: ‘It could be the medical director of a trust, a doctor, a nurse or even a management clerk.’
Dr Meldrum was asked how the scheme affected the government’s Patients’ Choice pledges.
He said: ‘It goes against the idea of patients’ choice which ideally should be with a decision taken between patients and a referring doctor.
‘It’s often Hobson’s Choice. Letters have been received saying that “because of financial problems we are limiting choice to one trust”.’
Dr Meldrum added: ‘We are not against planning to try to ensure a sensible use of NHS services.
‘We are not against audits of referral patterns and trying to improve them.
‘But we are against using referral management primarily as a tool to cut costs, delay treatments because of financial deficits, and to limit patient choice.
‘It doesn’t help anyone if referrals are simply bounced back to the referring GP without action, if patients are inappropriately sent to the wrong clinician, or if referrals get lost in a system of increased bureaucracy.’
Meldrum was asked are financial pressures driving more and more rationing.
He replied: ‘If you don’t have enough money to pay for things, you do either of two things – get into debt or don’t pay for things, and in the health service that means fewer treatments.’
A snapshot picture of referral management in England has been prepared by the BMA. It revealed that Primary Care Trusts were delaying referrals to the next financial year, looking to seek cheaper treatments, and in at least one instance, to pressure GP referrals to a private treatment centre.