National GP referral guidelines are needed to reduce inequalities
HSJ’s analysis of the first national collection of patient reported quality measures confirms what has long been suspected: better off patients undergo surgical procedures sooner after they develop health problems than poorer patients.
This pattern suggests the worst possible outcomes at both ends of the spectrum: healthier, wealthier patients treated too soon to bring about an improvement; poorer, sicker patients treated too late to benefit.
PCTs must ensure GPs in deprived areas carry out the screening necessary to identify those needing treatment before it is too late
The underlying causes are manifold. People in deprived areas have poorer health, are served by fewer GPs and are less likely to go to their doctor or be diagnosed if they do. Those in richer areas are more likely to bang on their GPs’ doors at the first sign of a problem and insist on an operation.
GPs seem to be too often giving in to this pressure, even if the knife is not the most beneficial course of action. Once patients have been referred, there is often no going back.
Without change, healthcare providers in poorer areas will continue to be financially penalised for treating sicker patients who potentially require longer stays, while in richer areas, primary care trusts and providers are bearing the costs of inappropriate elective referrals.
PCTs must ensure GPs in deprived areas carry out the screening necessary to identify those needing treatment before it is too late. In richer areas, GPs must be required to explain alternative treatment options and likely outcomes in full.
National referral guidelines like those produced by the National Institute for Health and Clinical Excellence for cancer would, no doubt, prove contentious - GPs may bristle at the perceived insult to their judgement, sharp-elbowed patients would complain at being turned away.
But if developed with the involvement of patients and royal colleges and policed fairly by clinicians, national guidelines could improve information for patients, reduce disparity in treatment and, significantly, potentially save the NHS millions of pounds.
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Readers' comments (2)
Anonymous | 30-Apr-2010 1:26 pm
As I see it there are two main ways of controlling costs in the NHS.
The first is to reduce referrals. The second is to limit the costs once a referral is made. In our are almost all effort seems to be in the 2nd area, looking ensuring right treatment first time (quality), appropriate pathways (inovation and productivity) and correct coding (process), to highlight 3 examples.
The first are seems to hardly get a look in, yet appears to offer significant scope for improvements. Improvements that would lead to lower costs and better patient outcomes. Perhaps it is time to introduce a triage of a referrals, as I believe some PCTs have. If the GP's feel it is an insult to the professional judgement then that is just too bad. If they get it right all the time then they needn't worry and the referral centre would soon be closed!
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GEORGE CALDWELL | 1-May-2010 6:02 am
It is the duty of the General Practitioner to see as many patients in one day as he comfortably can.
It is his experience of seeing so many patients, not by slow delayed appointments, but on a first come first served basis, that make him a valuable contributior to the general care of patients.
The waiting-room doors should open before 8 am. each day and in the evening say from 5.30 pm. As it pleases and suits the public.
Primary care patients wish to be seen as soon as possible after their symptoms appear. Yes? They don't expect surely to have a long sit-down consultation? It is not necessary. Nor wait for an appointment next week or two.
It has been reckoned that one in ten will need further investigation or referral.
Thus can a General Practitioner halt the flow of the unnecesary patient to the hospital doors. he should be capable of doing his own minor operations.
In a nearby Cottage Hospital there ought to be a Physiotherapist, good Laboratory and a Government Pharmacy dispensing perfectly adequate inexpensive nostrums which the modern Chemist refuses to make up and dispense. The National Formulary was full of them.
If only, as envisaged an agreed by the BMA in 1945 that the doctor was NOT salaried and was paid for the work he does then each doctor would have an incentive to do more work than he is doing at the moment.
A "salaried" doctor is no longer a Professional man. He has lost his independent thought and can be directed. And is he!
An innovation could be the invention of a plastic Medical Card with all important details encrypted and with one swipe as with an "Oyster card" on London buses, then the doctor's account is credited, and further credited for any extra work done.
Then would weekend work and night-calls be welcomed for the extra income involved.
A good idea?
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