If your GP has referred you to a hospital, you may have noticed the referral going via a referral management service. These were introduced in about 2003, and are a pathway that GP surgeries sign up to, who assess your referral before passing it on to the hospital for the clinic your GP wished to send you to.
According to Pulse (a GP news site), these services, which are often privatised, charge GP surgeries up to £10 per letter, to review all referral letters before they’re sent to hospitals. According to NHS North Durham CCG, unnecessary referrals can cost £150, and that these services are a cost-effective way of managing referrals. They are staffed by GPs and consultants, and their role is apparently to make sure ‘practice and community based solutions have been tried’. Some of these services simply advise GPs, but others are given then power to overrule referrals from a GP where they disagree with the referral.
Earlier this year, BBC News reported on these services causing unacceptable delays for people. It suggested that in 2013/14 28% of referrals were delayed for administrative reasons, and that this increased to 41% last year. These services also cost the NHS a staggering £19 million in 2015-2016. Both Pulse and the British Medical Association denounced these as blunt, inefficient, and dangerous, with the BBC giving an example of a woman whose referral was rejected and who was ultimately diagnosed with cancer.
At the end of last year, the BBC also reported on GP surgeries being given large sums of money for not referring patients to consultants, and reducing the overall rate of referrals. These rewards are totally misguided and encourage a culture in which GPs avoid referring patients to specialists based on finances rather than their perception of the patient’s need for a specialist.
In 2010, the Kings Fund looked into referral management services further, and produced a report analysing them. It concluded that while referral management services may fast-track urgent referrals such as cancer, they may also delay and lose referrals, not be cost effective (the figures above from North Durham CCG suggest that if an unnecessary referral costs £150, and each referral sent through the service costs them £10, then the break even point is rejecting one referral out of every fifteen).
The Kings Fund also suggested that offering financial incentives may demotivate GPs and cause them not to send necessary referrals, as well as causing a conflict of interest. It suggested that using a ‘peer review’ system to look at referrals, run them by a consultant if necessary to judge their importance with ‘clear criteria and evidence based guidelines’ was the most likely to save money without causing patient harm. Despite this, the BBCreported that there has been a ten-fold increase in the use of these services.
They are not being used simply for financial reasons – although that would be bad enough. These services are being used for ideological reasons – to ration access to necessary healthcare. With 41% of referrals being delayed, the wait to see a specialist only increases, and while the wealthier can afford to see a private clinician if they cannot wait, that option isn’t open to the rest of the population. Of course, the goal is to divert as many people as possible to private services, and to privatise access to healthcare for the rest of them. If the Conservative party wins the 2017 general election, we will see a further increase in the use of these services, accompanied by a decrease in the quality of the NHS. Make it fail, chop it up, sell it off, that’s their goal, and if we’re not vigilant, they’ll achieve it.