Doctors vote against referral centres

Many primary care trusts use “referral centres” or other procedures to review whether referrals to specialist diagnostics or treatment are appropriate, before passing them to providers. It is an attempt to reduce demand for secondary services and so reduce cost.

The British Medical Association annual representative meeting in Cardiff on Monday strongly supported a motion attacking such systems. The motion said: “This meeting believes that the decision to refer for further care is made between a GP and patient, following a clinical assessment and rejects the use of referral centres and other crude methods to reduce referrals for financial reasons rather than the benefit of patients.”

It was proposed by Gillian Beck, a GP in Buckinghamshire, an area with advanced clinical commissioning and covered by early “pathfinder” clinical commissioning groups. She said she had “received a referral quota - four-and-a-half per week - including emergencies”.

She said: “Bucks is a pathfinder for cuts… Why should a third person [apart from the patient and GP] be allowed to access confidential information to choose that they want my patient to go somewhere entirely different.”

However, in a separate motion that was passed, the same meeting called for the government to make nationally imposed decisions about the availability of some treatments. Proposer GP Chand Nagpaul said some patients were being denied treatments “simply because of their postcode”.

The motion said: “This motion deplores the variable definitions and thresholds of ‘low priority’ treatments that are being implemented in different primary care organisations, which are denying patients equitable access to services nationally, and this meeting calls for consistent national standards and thresholds of services available to patients on the NHS.”

The meeting also passed a motion declaring the “requirement for year end financial balance in NHS organisations can endanger quality and safety of service delivery”.

BMA chair Hamish Meldrum, supporting the motion, said: “Nobody is saying you can ignore the financial realities but we’ve seen - not least at Mid Staffordshire trust - some of the reckless decisions taken as a result of [financial] constraints on managers.”