GP and patient groups are concerned about a possible new strategy that would stop GPs from referring directly to NHS specialists.
The approach, called ‘advice and guidance’, would instead require GPs to first discuss a patient’s case with a hospital consultant before making a referral.
GPs often refer to specialist care when a patient has specific symptoms, such as a suspicious birthmark or an unusual blood test result, that require further detailed medical examination.
The advice and guidance policy is already being used in some parts of England, but NHS leaders are considering rolling it out nationally. A final decision will be made in a national outpatient strategy to be published in December.
Fans of the model claim it can help reduce the number of unnecessary referrals, saving time for both the patient and the NHS.
However, GPs fear the system could be used to create an ‘artificial barrier’ to prevent NHS waiting lists from growing any further, add more paperwork to overworked GPs and ‘prevent patients from accessing care’ get what they need’.
GPs and patient groups are concerned about a possible new strategy that would stop GPs from making direct referrals to NHS specialists (stock image)
Professor Kamila Hawthorne, chair of the Royal College of General Practitioners (RCGP) told MailOnline that GPs were concerned about the model.
“In our ongoing discussions with NHS England about a national outpatient strategy, we have raised concerns about any proposal to insist that all GP referrals must come through the ‘advice and guidance system’,” she said.
Professor Hawthorne said GPs who were already using advice and guidance had given mixed feedback about the way it was being implemented.
She said: ‘We have seen variations from region to region, with some of our GPs saying that, if deployed properly and implemented well, it is a useful tool to improve communication with their colleagues across the rest of the system. improve.
‘In other countries it appears to be used as a barrier to artificially protect waiting lists and prevent patients from getting the care they need.
‘This could have significant implications for GPs who are already overworked and face the spillover of a greater number of referrals being delayed or rejected.’
Professor Hawthorne added that the RCGP fully supported a closer relationship between primary and secondary care, but that patient care was paramount.
‘Advice and Guidance’ should only be used to do what the name suggests, to provide advice and guidance, rather than acting as a barrier to timely patient referrals,” the company said.
Patient advocacy groups are also wary about what advice and guidance could mean for waiting times.
Dennis Reed, director of Silver Voices, which campaigns for older Britons, said on this website that it was ‘concerning’.
“It’s like another way to ration patients,” he said.
‘It creates an additional bureaucratic barrier to referring people to advisors.’
He added that he imagined such a policy could add “a few weeks” to the time it took for patients to successfully get a referral to their GP, even if they needed it.
“The concern is that there will be a back-and-forth correspondence between the GP and the hospital consultant,” he said.
Mr Reed also criticized the policy of infantilising GPs.
‘It also calls into question the professional competence of GPs, they are essentially saying: ‘It is up to us to decide whether your referral from this person is justified or not,’ he said.
The Health Service Journal reported that health leaders are considering significantly increasing the use of advice and guidance in England.
The latest GP workforce data for May 2023 shows there are 27,200 fully qualified GPs in England. This is a decrease compared to the 27,627 a year earlier. The GP number peaked in March 2016 at 29,537
They cited NHS data showing that where the system was implemented it prevented 70,000 GP referrals, while consultants determined these were unnecessary.
On the possible plan to roll out advice and guidance more widely, an NHS spokesperson said the health service was ‘still seeking views on proposals’.
They added: ‘The NHS is actually making it easier for people to get specialist advice, for example by giving GPs the power to order diagnostic scans for cancer without having to make a hospital appointment first, or through hospital consultants taking part in weekly meetings with general practitioners to discuss patients. ‘treatment options.’
A spokesperson for the Royal College of Physicians, one of the groups consulting with NHS England on the outpatient strategy, said: ‘We are pleased to be working with doctors, patients, managers, health leaders and healthcare providers at every level to achieve this doing.’
‘Fundamentally, we all agree that we need this integrated approach and that any recommendations, once fully developed, should address any impact on all sectors to improve patient care.
‘The Advice and Guidance Model is not new and is already part of what general practitioners and specialists do.
‘Ideally, communication between the GP, specialist and patient could speed up care, with early advice and, if necessary, transfer to a planned pathway of specialist care.’
A spokesperson for the Department of Health and Social Care said: ‘Reducing waiting lists is one of this Government’s top priorities and transforming outpatient services is vital to ensure people can get the care they need, when they need it.
‘Providing GPs with access to advice and guidance supports faster diagnosis and treatment and ensures patients receive the right support in the right care setting.
‘If a patient does need to be seen by a specialist, specialist advice ensures that the right doctor can be identified at an earlier stage in the process, making better use of the time spent on the appointment.’