An attempt by NHS England to protect patient choice by preventing hospitals closing their doors to ‘out of area’ referrals has been strongly criticised by a leading foundation trust chief executive.

Salford Royal Foundation Trust chief executive Sir David Dalton told HSJ that forcing referrals on stretched trusts was akin to “asking a hotel to keep accepting bookings when all their rooms are full” and could potentially “jeopardise safe care”.


NHS England’s ‘out of area’ referrals move could ‘jeopardise safe care’, Sir David Dalton said

His comments were in response to a proposed change to the NHS standard contract, published by NHS England this week. The organisation’s consultation document said: “We intend to address concerns that some patients seeking to exercise their rights to choice… may be prevented from doing so by the implementation of policies by certain providers under which referrals from outside their immediate local area are declined.”

Providers would be required to accept every referral, regardless of the responsible commissioner “where this is necessary to enable a patient to exercise his/her legal right of choice of provider”.

In recent months it has emerged that several leading trusts are refusing to accept patients from outside their immediate areas. This is because they are concerned increasing activity could prevent them hitting 18 week elective waiting time targets.

Those involved include Salford Royal, University Hospitals Birmingham FT, Oxford University Hospitals Trust, and Hull and East Yorkshire Hospitals Trust. The practice has been questioned by health minister Dan Poulter.

Sir David, who has advised Jeremy Hunt on several issues in the past 18 months, told HSJ that patients should be able to choose from providers that have capacity. But he added: “To insist that trusts that have fulfilled their contractual obligations have to accept more patients than they have the capacity to treat, means that patients will suffer longer waiting times, when there are alternatives, and have the possibility of sub-optimal treatment as a consequence.”

He said his area had seen a 15 per cent increase in referrals in some specialties in the past year, which he believed was because “something has changed in the GP referral threshold”.

“This is a demand management issue which must be addressed by commissioners with GPs. It suggests to me that we need radically different systems of clinical governance for primary care,” he said.

Meanwhile, HSJ has also learned that sector regulatory Monitor has written to University Hospitals Birmingham expressing concern over its rejection of some of its out of area referrals.

The letter, sent in October and seen by HSJ, said: “We are concerned to ensure that refusals to treat patients in respect of these particular services are being made on appropriate clinical grounds only, and that where patients reside is not a determining factor in those decisions.”

It was ignored by the FT, which has continued to turn away out of area patients in six specialties.

A trust spokeswoman said: “We will study NHS England’s announcement carefully and take advice.

“However, can it be right that we would have to accept a referral from 300 miles away when it meant turning down a local patient? This would clearly disadvantage those who have a disability or could not afford to travel.”