Published: 21/11/2002, Volume II2, No. 5832 Page 6 7

The zero-star trust which ignored a backlog of thousands of ultrasound requests has urged local primary care trusts to re-examine the appropriateness of their referrals.

Barnet and Chase Farm Hospitals trust said the lack of evidence that any patients came to any harm - despite a backlog of 2,700 scans which built up by September 2001 - implies a problem with the quality of referrals.

An investigation by the Commission for Health Improvement last week revealed that referrals for scans had been stored in a filing cabinet and ignored for as long as 19 months.

'It was only a matter of luck that no patient suffered an adverse outcome, ' said CHI medical director Dr Linda Patterson.

The investigation flagged up the fact that GPs accustomed to long waits for diagnostic tests at Chase Farm Hospital had found ways of 'working around' the system by making further requests if cases became urgent.

But Paul O'Connor, trust chief executive since February, and now running the trust on a franchise, said the fortunate lack of harm caused also suggested that some referrals were being made unnecessarily and that GPs were making multiple requests at several hospitals.

He told HSJ: 'It raises questions about the quality of referrals and there is anecdotal evidence that there has been multiplicity of referrals.'

Mr O'Connor said the problem 'probably reflected a bit of their frustration that waiting times in London in particular are so long'.

He said the trust was now working on drawing up specific protocols with primary care trusts to make sure referrals were appropriate. He said there was now no backlog of referrals, while waits are down to two weeks for urgent cases and eight weeks for routine cases.

An investigation by North Central London strategic health authority last month ordered the trust to carry out a 'failsafe' exercise on 543 patients who had been referred back to see their referring clinician or did not attend the ultrasound appointment they were given.

Mr O' Connor said that even when the trust got in touch with GPs for the second time, only a third of doctors responded and they said there had been no adverse consequences because of the failure to carry out a scan.

He told HSJ: 'You can tell people and you can tell them a second time but I do believe the ball is in their [the GPs'] court. I am not prepared to do that any more.

'I am not making that statement out of a stance of any bravado - I think it just reflects the lack of adverse outcomes... and that does call into question the number of referrals made.'

Mr O'Connor said that since February, the trust had done a lot of work 'to rebuild relations with PCTs'. It has made a joint appointment with Barnet PCT of a head of service integration, Celia Gaze, to examine demand issues across primary and secondary care.

The CHI investigation also revealed rows between consultants about the amount of private practice being carried out. An allegation that private practice was being carried out in NHS time was subject to an investigation by the NHS Counterfraud Operational Service, but no prosecutions have been made.

The investigation by CHI, which was prompted by a clinical governance review, has flagged up tensions in the relationship between investigators and trusts under scrutiny.

When the investigation was opened in February, the trust said it had alerted CHI to the problems in November, while CHI insisted it had not known about the backlog until a meeting in January.

This week, relations appeared further strained when the commission prevented trust director of communications Nick Samuels from responding to journalists' questions at the press conference called by CHI.

A spokesman for CHI said Mr Samuels had agreed to attend the conference as an observer and said it would have been 'inappropriate' for him to have fielded questions at CHI's event.

He added: 'There is nothing Machiavellian or paranoid about it. If we are to be perceived as an independent regulator, then we cannot be giving a platform to the organisation that is being investigated.'