British patients are switching to private care to escape ‘black hole’ of referrals, GPs say
Patients are increasingly turning to private healthcare to escape a referral ‘black hole’, GPs have warned, as the NHS faces a shortage of available appointments.
The latest figures show that GP practices make around 400,000 referrals a month to outpatient clinics that are fully booked. Some patients are able to choose an alternative provider, others are booked at a later date, but many are ultimately referred back to their local practice.
Dr Dean Eggitt, a GP in Doncaster and chief executive of the borough’s local medical committee, said: “I think the NHS has collapsed because it no longer provides universal care. I say to a patient, ‘I can refer you, but it’s not going to be fixed in a year and I can just help you deal with it.'”
Eggitt said he has discussed private sector care options with patients, with many choosing to pay for some of their care themselves. Analysis A report published in May by the Nuffield Trust found that the number of people paying for hospital care in the UK has increased by 30% since the pandemic.
GPs typically refer patients to outpatient clinics using the NHS e-referral service, which can also be used by the patient to book a suitable appointment. The most recent figures, More than a million appointments had been booked in England by July, but in 407,173 cases there were no places available.
The number of unavailable places has increased by 78% since July 2018, when the comparable figure was 227,937. There was a severe shortage of appointments in orthopaedics, cardiology and diagnostic imaging.
NHS England has warned that the lack of available appointments “creates a significant amount of avoidable administrative work and could cause patient safety issues”. Providers are contractually obliged to ensure that sufficient appointments are available for initial outpatient appointments.
GPs are struggling with patients becoming increasingly ill because they cannot get NHS appointments. They are also concerned about patients being systematically turned away for appointments.
Dr Ellen Welch, a GP in Carlisle and vice-chair of the Doctors’ Association UK, said: “Patients sometimes have to wait years before they can see a specialist team about a problem, but they come back to us time and again for treatment in their GP practice.
“We have noticed that referrals have been repeatedly rejected by hospital teams, often for bureaucratic reasons.”
GPs across the country have warned that they believe there is now effective ‘rationing’ of referrals to outpatient clinics.
Prof Kamila Hawthorne, president of the Royal College of General Practitioners, said the latest figures for unavailability were concerning. She said: “GPs are very well trained to make appropriate referrals when necessary, ensuring patients get the specialist care they need. While we recognise that secondary care is under enormous pressure, it is essential that referrals from GPs are taken seriously and not rejected without very good reason.”
Healthwatch England, which collects the views of health and social care users in England, warned last year that an online survey had found that one in five patients referred for specialist care had fallen into a “black hole” and been sent back to their GP.
This involved patients whose appointment had been cancelled, or who had been referred to the wrong service, had been removed from the waiting list or had not heard anything more about the referral.
Helen Hughes, chief executive of the charity Patient Safety Learning, said there were concerns about the safety of patients who were unable to get specialist care in a timely manner. She said: “Patients waiting for care need to be monitored and re-prioritised as their level of need is likely to change while they are waiting.”
According to NHS England, some patients could be turned away from an appointment when there were more suitable care options, but this only happened in 2% of referrals.
An NHS spokesperson said: “While NHS staff work hard to deliver tens of millions of outpatient appointments each year, it is clear that more needs to be done to provide timely care to those who need it.”
A Department of Health and Social Care spokesperson said: “We inherited a broken NHS and it is unacceptable that so many people are having to wait longer than necessary for care.
“We know waiting lists are too long, and that’s one of the reasons why the Health Secretary has ordered a full independent inquiry into the state of the NHS to expose the scale of the problem.”