03 March 2006
NHS referral management centres are being used to ration care and prolong waiting times, the British Medical Association said this week.
Traditionally, patients are referred to hospital consultants by their GP directly, but referral management centres are increasingly acting as go-betweens, deciding where best to send patients.
In most cases, this will mean arranging an appointment with a consultant, but some patients may be referred to another health care professional, such as a GP with a special interest or a physiotherapist.
BMA GP leader Hamish Meldrum said referral management helped some patients receive the most appropriate care.
But he added: 'In other places 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.'
The Department of Health has admitted that one of the centres' key roles is to curb demand for acute hospital services. The BMA alleged this amounted to rationing.
The doctors' claims were rejected by NHS Confederation chief executive Gill Morgan. 'Referral management schemes help to ensure that the most urgent patients receive care faster, that all of the care options are evaluated and that the most appropriate treatment is provided,' she said.
'A process that helps patients receive the right care in the right setting is not about rationing services or prolonging waiting times – it's about improving the patient experience, something that should be supported and not condemned.'
However, the King's Fund echoed the BMA's disquiet. Its chief economist, Professor John Appleby, said: 'Given that the contracts agreed with the new independent treatment centres guarantee a certain level of referrals from GPs, with the threat of financial penalties to the NHS if those levels aren't reached, we are worried that these referral schemes will be allowed to coerce doctors and others to refer patients to these centres.'
He added that more clarity was needed over how referral schemes work, 'to ensure that GPs and patients are not inappropriately directed to any particular hospital'.
PFmar2006
