Referrals by GPs shot up in spring - putting extra pressure on trusts battling with December's 18-week referral to treatment target.

Figures obtained by HSJ from strategic health authorities for all GP referrals suggest many primary care trusts saw a surge in referrals to secondary care in April and May - with rises of 20-40 per cent on the same period last year in many cases.

Peterborough PCT saw a rise of 41.4 per cent, Torbay Care trust saw one of 38.6 per cent and Northamptonshire teaching PCT saw referrals up by 66.8 per cent.

The Department of Health's own figures are lower. It said the year-on-year rise in GP referrals was 12.7 per cent for general and acute specialties. These exclude learning disabilities, mental health and obstetrics.

Mystified PCTs

The early Easter may explain some of the rises: there were 42 working days in April/May this year but 40 last year. The DH said its figure would come down to 9 per cent allowing for this.

The rise has mystified PCTs. Peterborough PCT associate director Sarah Shuttlewood said: "There is no obvious reason why it suddenly started to rise in April and May."

The PCT was discussing possible causes with GPs. It has commissioned extra capacity in some specialties and looked at additional providers. Although it says referrals dropped again in June, they were still higher than last year. The PCT is ahead on 18 weeks and does not expect the April/May bulge to jeopardise this.

Torbay Care trust said the rising elderly population in its area may have affected its referrals.

Northamptonshire PCT said it is undertaking work to understand the rise and any steps needed.

NHS Alliance spokesman David Jenner said there were likely to be multiple causes. "However, the GP pay rise does not encourage more to be done in-house and goodwill has been lost," he said.

Changes to the General Medical Council standard of proof for disciplinary hearings may also have encouraged defensive medicine.

REFERRAL RISES BY SHA

GP referrals

(SHA data)

Referrals to general and acute (DH data)

East Midlands

21.9

12.6

East of England

15.9

13.7

London

18.4

10.1

North East

15.4

10.4

North West

9.0

15.2

South East Coast

17.0

10.4

South Central

8.0*

14.3

South West

17.3

14.1

Yorkshire and Humber

**

11.9

West Midlands

15.0

13.1

Figures show percentage change in April and May compared with last year. Not adjusted for working days.

*April only

**Figures not provided