Below is a disturbing article from yesterday's Sunday Telegraph. Can it really be true? It seems like a grotesque parody of how the NHS is now working. I would like to see more sources identified to be fully confident that the situation is as described. But if the story is, indeed, true, then the Government has set up - or has allowed the creation of - a new layer of bureaucracy which in theory exists to speed up access to consultants but, in fact, delays access to them. In short, it is a new way of hiding the waiting list and a new way of denying access to patients whose doctors think they would benefit from such access. It puts together a waste of resources (the new offices and personnel) and a denial of healthcare to those who need it. It appears to add to the evidence that the reduction in the waiting lists - which is assumed by most observers to be an uncontested fact - is, in reality, exaggerated or a lie in which this dishonest government and frightened officials in the NHS collude.
The paperback edition of The Welfare State We're In has a extra small chapter called The NHS: so did it get better? In that, as well as looking at the under-prescription of new cancer drugs (which suggests that thousands of people are continuing to die each year because we rely on the NHS rather than having a European system of average quality) I look at the boasts about waiting lists and conclude they are highly misleading. Having said that, I should add that I believe the King's Fund has recently issued a report which supports, at least in part, the government's claim that waiting lists have been greatly improved. I have not yet seen this report and so cannot comment on it.
Here is the Sunday Telegraph report:
New centres that "screen" patient referrals from GPs to hospital consultants are being used by the NHS to ration health care by stealth, say medical professionals.More than a third of primary care trusts (PCTs) have established "referral management centres" that, critics say, are preventing patients from seeing the doctor of their choice and in some cases are prolonging waiting times in order to save cash.
In one case, GPs found thousands of referral letters stashed in a cupboard for weeks.
Patients' groups and doctors' leaders say the referral schemes, which are sanctioned by the Department of Health, are creating another tier of NHS bureaucracy and could actually harm people's health.
GPs say some centres are refusing to let patients see consultants sooner than the Government's outpatient target of 13 weeks. This limits the number of appointments in any one year - saving the PCT money.
In some trusts, people are being sent back to their GPs by doctors employed by referral centres, who decide they are not sick enough to warrant a hospital consultation.
In a survey carried out by the medical magazine Pulse, 10 per cent of all PCTs admitted they had a specific target to cut GP referrals.
When patients in Milton Keynes started complaining of long delays, their GPs investigated. Milton Keynes PCT had set up a referral management centre, which was meant to scrutinise all referrals in order to speed access and ensure patients got the right treatment. But Dr Peter Berkin and colleagues discovered a backlog of more than 2,000 letters locked in a cupboard by the centre's secretaries until just short of the 13-week waiting-time target.
"It got really scary," said Dr Berkin. "There were cases that could have been very serious and needed to see a consultant quickly. We were horrified. The decisions were taken by secretarial staff, not doctors."
A spokesman for Milton Keynes PCT admitted there was a backlog, but said it had mostly been dealt with.
Katherine Murphy, of the Patients' Association, said: "These centres are springing up all over the place, but who's monitoring what they're up to? It seems to be another way of rationing patient care by stealth." Dr Hamish Meldrum, chairman of the British Medical Association's GPs' committee, said: "There is considerable concern among doctors. Where clinicians have been involved, things may be working well, but in other places there has been no effective consultation and it seems the main intention is to cut costs. This is potentially harmful to patients' health."
A Department of Health official said referral centres were a "local initiative" by PCTs, but national guidance had been issued on running them. "They must only be set up where they will have clinical benefits and should add value to patient services. They should not conflict with giving patients more choice [and] must not lengthen the patient journey or create 'hidden' waiting times."
Posted by James Bartholomew • Indexed in NHS
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Terrifying new development, as if seeing a consultant isn't long and difficult enough. I get really sickened when I see the NHS discussed on the news. It's like the MPs don't understand or don't want to acknowledge the estent of the problem.
Posted by: Leah Rachel at October 21, 2006 01:08 PM
It's true. This is from 'Doctor':
How to combat interference in referral choice.
There is a glaring anomaly in the Government’s patient-choice agenda – the widespread adoption of referral management centres.
When it works, Choose and Book may offer patients greater choice, but referral management centres take it away. It is a topic that often unites GPs and hospital doctors through mutual disdain.
Not only do such triage centres impose a middleman into the GP-specialist relationship, they take away doctors’ fundamental role of deciding what is in the best interest of their patients.
Anecdotal evidence shows they cause delays and, in some cases, result in bounce-backs, inappropriate referrals or patients being lost to the system altogether, with GPs left to pick up the pieces.
At this year’s annual representative meeting of the BMA, GPs called for a campaign against the widespread adoption of referral management centres.‘They are bad for patients, bad for doctors and bad for the NHS,’ representatives said.
This week we reveal how a group of Merseyside GPs have used their initiative to reclaim their right to refer from a local referral management centre.
They discovered that all their rheumatology referrals were being automatically redirected to a physiotherapist, leading to unnecessary delays in treatment – even for urgent cases. More galling was that patients were being told that the GP had requested the physiotherapist appointment, when they quite clearly had not.
The GPs in question have come up with novel ways of bypassing the system, by faxing consultants directly.Their LMC has now championed their idea.
Nationally, practice-based commissioning may also offer a chance for GPs to develop their own in-house referral system for patients. GPs can take back the right to refer to the specialist of their choice, if they choose to.
Publication:DOC; Date:Oct 17, 2006; Section:News; Page:5
Posted by: Dr Grumble at October 21, 2006 02:52 PM
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The NHS reality, in any case, is one of rationing-by-queue. A month or two ago, my 95-year-old mother-in-law was referred to a consultant by her GP after experiencing blackouts. The consultant said she should have a test done, for which the Conquest Hospital in Hastings had a waiting list, on the NHS, of nearly six months. However, the same department, using the same staff, the same facility and the same equipment, eagerly offered the test privately, even calling proactively to offer a convenient, and quick, appointment. Of course it's rationing. Additionally, when very old people are made to wait for treatment, then a sizeable proportion will succumb to that or another ailment before it can actually take place ...
Posted by: Philip Talmage at October 16, 2006 08:33 PM