This is a grim account of one way in which treatment in the NHS is, effectively, being delayed. None of this, I assume, will appear in the calculation of 'waiting lists'. So this is also another way in which the waiting list calculation is being manipulated. To put it more bluntly, it is anothe way in which the waiting list figures are lies.

Family doctors say that new "referral management" systems, set up to allow primary care trusts (PCTs) to overrule decisions taken in the surgery, are being used to delay and cancel hospital care, and to divert patients referred to a hospital consultant to cheaper clinics in the community.

Other schemes run by PCTs have offered GPs payments if they reduce the number of patients sent to hospital.

Of 750 doctors polled across Britain, 75 per cent said they had referred patients to hospital only to have their decision overruled, with 40 per cent saying that it happened regularly. Dr Laurence Buckman, the chairman of the British Medical Association's GP committee, himself a London family doctor, said such schemes were a short-sighted attempt to save money by delaying hospital care.

"If I think my patient needs to see an orthopaedic surgeon, the chances are they do," he said. "These kinds of schemes just set up an extra layer, which delays the patient getting to see the right person."

Dr Buckman said he believed the schemes were "simply about saving money" by delaying hospital bills. "Most PCTs are on the verge of bankruptcy and if they can find a way to defer payment until the next quarter, or next financial year, they will," he added.

Norman Lamb, the Liberal Democrat health spokesman, said that GPs in his North Norfolk constituency had complained to him after referrals for teenagers requiring psychiatric help were delayed, while local PCTs had introduced "minimum waits" for surgery in order to push hospital bills into the next financial year.

He warned: "Patients will be confused. They will trust their GP to make the right judgment and when their referral comes back, they can only assume it was for financial reasons."

Katherine Murphy, from the Patients' Association, said her group was hearing a growing number of complaints from orthopaedic patients who believed their health had worsened after they were diverted for treatment by a physiotherapist when their GP had intended them to see a surgeon. She described the policy as "a prime example of deficits putting lives at risk".

Paul Rybinski, a GP in Croydon, Surrey, said doctors were under increasing pressure to reduce hospital referrals to save NHS funds. His own practice has a referral cuts target of 5 per cent.

Dr Rybinksi said he feared "referral centres" would make decisions based on very partial knowledge of the patient. "When I make a referral it is based on a complex decision relating to the individual in front of me. It is very difficult for a panel at a PCT to second-guess what I was thinking, and the factors I was taking into account, based on a reading of a basic referral letter."

The poll, by Pearl Medical, which provides mobile communications to GPs, also found that doctors strongly opposed Government plans to create networks of "polyclinics", replacing individual GP surgeries with huge group practices, serving populations of 50,000.

The full article in The Sunday Telegraph is here.

Posted by James Bartholomew • Indexed in NHS

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