“NHS organisations are paying millions of pounds to private firms that stop patients being referred to hospital by their GPs, an investigation has found.
Controversial referral management centres are used by some clinical commissioning groups (CCGs) to scrutinise patient referrals to hospitals by family doctors.
Supporters say they can reduce inappropriate referrals, saving the NHS money, but critics argue that adding an extra layer of scrutiny risks delaying diagnosis. There is also doubt over the effectiveness of such schemes.
GP practices ‘offered rewards’ for not referring patients to hospitals
In an investigation, the British Medical Journal (BMJ) sent freedom of information requests to all 211 CCGs in England. Of the 184 that responded, 72 (39%) said they commissioned some form of referral management scheme.
Almost a third (32%) of the schemes are provided by private companies, while a further 29% are provided in-house and 11% by local NHS trusts. Some 69% of the CCGs with schemes gave details of operating costs. These CCGs combined have spent at least £57m on schemes since April 2013.
Most CCGs were unable to provide evidence showing the scheme saved money. Only 14% could show that the scheme had saved more cash than it had cost to operate, while 12% showed that their schemes had not saved money overall.
Meanwhile, 74% of CCGs (53 groups) failed to supply figures to show whether any money had been saved, the BMJ reported.
Some CCGs did not collect data on savings, some said their referral scheme was designed not to save money but to improve the quality of referrals, and others declined to disclose details of savings on the grounds of commercial confidentiality.
Overall, there were 93 referral management schemes in operation across 72 CCGs, with some CCGs having more than one.
Dr Richard Vautrey, deputy chairman of the British Medical Association’s GPs committee, told the BMJ: “[CCGs] are leaping at these schemes without any clear evidence of benefit. They are just hopeful that it might reduce their costs.
“It is a very short-term approach to healthcare management. We need to see much more evaluation … and not just keep making the same mistakes year after year. As public bodies, there should be an expectation on every CCG to account for what it is doing.”
Vautrey said some schemes were helpful because they gave GPs rapid access to advice from local specialists.
Graham Jackson, co-chair of NHS Clinical Commissioners, the membership organisation representing CCGs, said referral management was only one way of managing demand for services.”
Owl bets that, if NEW Devon CCG hasn’t yet done this, it will be champing at the bit to commission a scoping study for a feasibility study for a consultants report for a pilot study at a health hub near you!
“In many cases they provide a useful and effective role which is more than a redirection service,” he said. “CCGs will balance the cost of commissioning with the benefit they provide to GPs and patients in terms of peer review, education, caseload management and choice.”
In October, Roberta Blackman-Woods, Labour MP for City of Durham, criticised a local scheme to screen referrals for conditions including cardiology, gynaecology and gastroenterology.
The North Durham CCG has awarded a contract to the private firm About Health to manage referrals.”