A foundation trust has become the first in the country to turn patients away after the escalation of a public row with its primary care trust over funding.
Up to 1,800 patients could be sent back to GPs - the first time a trust has refused to take non-urgent referrals since the introduction of payment by results.
HSJ understands foundation trust regulator Monitor has called Royal Bournemouth and Christchurch Hospitals foundation trust, Bournemouth teaching PCT and their strategic health authority into a crisis meeting in an attempt to end the stand-off. The Department of Health has also been invited to attend.
Foundation Trust Network director Sue Slipman told HSJ there were nine other cases in the pipeline, worth£28m, where PCTs and foundation trusts cannot agree funding for activity.
The Bournemouth dispute concerns£6.3m the trust claims it is owed for last year and the failure to agree a contract for 2006-07.
RBCH foundation trust accused its PCT of 'refraining from funding life-saving drugs and complex heart treatments' and said the PCT had 'requested' the stop on non-urgent referrals. In a statement, the trust said 'potentially up to 1800 patients may not receive the care they require', as these referrals were 'in excess of what the PCT had agreed to pay'.
But PCT chief executive Debbie Fleming said it had been the trust's decision to stop the non-urgent referrals: 'We are very disappointed that the foundation trust has found it necessary to stop accepting routine referrals as we believe this action to be both inappropriate and unnecessary,' she said. And it will not stop the problem of over-performance.'
GP referrals fell by 7 per cent over the past year, but internal trust consultant-to-consultant referrals soared by 26 per cent, she added.
The NHS Alliance and British Medical Association believe this is the first case where a dispute over funding has led a foundation trust to turn patients away.
NHS Alliance chair Dr Mike Dixon said: 'It is inevitable that there will be friction within the system while the correct relationship between commissioners and providers is established. We must make sure patients are not harmed while the dust is settling.' Acute trusts had to understand that PCTs were becoming 'empowered commissioners', he added.
But BMA consultants committee chair Dr Paul Miller slammed the PCT. 'It is understandable that a trust will not do work that nobody will pay for and [this] shows how the system is failing to work correctly. It is ridiculous to have staff and facilities standing idle when patients need treatment.'
Ms Slipman blamed PCTs for causing funding problems for foundation trusts: 'It is clear that we have got a real problem with commissioning that is not fit for purpose. Either PCTs have to manage demand, which they are not doing, or they have to pay for the work.'
Royal Bournemouth and Christchurch Hospitals foundation trust chief executive Tony Spotswood said: 'We have the staff and facilities to treat all patients that are referred. The hospital must, however, be paid for the work that is carried out ? this is national policy.'
He told the PCT that 25 to 40 per cent of elective referrals would have to be turned away. The trust estimated a shortfall in funding for up to 11,000 treatments, which could lead to the closure of some services.
Ms Fleming said the PCT had contingency arrangements in place to send patients to any of 12 other providers. 'We are keen to see an end to this dispute as soon as possible and we are using the formal disputes resolution process laid down in the contract.'
She said last year the acute trust carried out many more operations than had been agreed in its contract with the PCT. This was unnecessary as waiting times in Dorset were already some of the lowest in the country and the PCT did not have the funds to pay for additional work, she said.
A DoH spokesperson said it was 'aware of these issues and is considering them with Monitor'.
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