Three further trusts have imposed controversial curbs on patient access to services by restricting referrals from outside of their catchment areas, HSJ has discovered.

Hull and East Yorkshire Hospitals Trust, Oxford University Hospitals Trust and Salford Royal Foundation Trust have all blocked some referrals as they sought to throttle demand over the past year.

They bring to four the number of trusts known to have restricted out of area referrals.

As reported by HSJ in September, University Hospitals Birmingham Foundation Trust has begun blocking routine referrals from outside the area across several specialties in a move which has raised concerns about patients’ choice.


Oxford University Hospitals has stopped accepting routine spinal referrals from outside the area

In all of the three new cases identified by HSJ the curbs aim to help the hospitals hit the 18 week referral to treatment target.

Hull and East Yorkshire Hospitals Trust last December restricted out of area referrals for neurosurgery by switching from the choose and book electronic system to paper referrals and triaging each one.

A trust spokesman said neurosurgery referrals had increased 20 per cent over the past two years. “To ensure we continue to deliver a high level of safe care to our patients, the trust took a decision, along with a number of other organisations to restrict out of area referrals,” he added.

This restriction is expected to remain in place until April 2015.

Oxford University Hospitals Trust agreed with its commissioners in April to stop accepting routine spinal referrals from outside the area, resulting in 27 patients being turned away.

This restriction will remain in place for the rest of this financial year and is due to be reviewed after April.

Paul Brennan, director of clinical services at Oxford University Hospitals Trust, said the policy was necessary because referrals for spinal complaints had “increased significantly” over recent years.

Salford Royal Foundation Trust

Salford Royal FT has imposed several restrictions to clear backlogs of patients waiting for treatment

“The caseload exceeded the capacity of the services to treat patients within the required 18 week timeframe by a growing margin.”

Salford Royal Foundation Trust has also imposed several restrictions to clear backlogs of patients waiting for treatment, it revealed.

In June, it suspended Mohs micrographic surgery, a form of skin cancer treatment, after discovering patients had been treated out of chronological order to avoid breaching the 52 week target, a situation the trust says was ““clearly unacceptable”. Target breaches carry a £5,000 fine per patient.

It also this year restricted orthopaedic referrals after discovering a large backlog of patients waiting for treatment. Both suspensions have now been lifted.

A spokeswoman for Salford Royal said: “Despite a unit expansion in both workforce and physical space the Mohs service was under significant pressure in its ability to see patients within the referral to treatment target. More than 60 per cent of patients were referred to the service having already breached 18 weeks. 

“As a result of the late referrals, patients were seen out of chronological order in order to deliver the 52 week threshold for treatment, disadvantaging others.”

“On 1 June, following discussions with NHS England specialist commissioners, a work programme was agreed and with reluctance the service was restricted for a period whilst the backlog was cleared.”