• Guy’s and St Thomas’ Foundation Trust in south London has restricted some referrals
  • Curb relates to specialist paediatric work but trust talking to commissioners about also limiting some adult services
  • Elective demand three times what trust had planned

A major London teaching hospital has restricted referrals from out-of-area in response to unprecedented demand for its services. 

Guy’s and St Thomas’ FT has limited access for some “very specialist services” in paediatrics and is considering further limitations for adult services.

Minutes of the trust’s quality committee meeting this month said the trust’s waiting list had grown in the face of demand which was three times what was planned.

The document read: “The committee noted the analysis of the problem and the supportive discussions with local commissioners about introducing a number of geographical restrictions for referrals, particularly for some paediatrics specialties. It was noted that this would not meet the trusts’ obligations under the NHS Constitution.

“It was noted that some trusts were opting out of providing services especially in hard-to-staff areas or where there were tariff disincentives – for example, some dermatology services.

“Core services as part of trusts’ FT authorisation had to be provided and there were daily requests for the trust to accept referrals from other, fragile services which were not automatically accepted.”

HSJ understands the organisation has seen an unprecedented increase in patients from north London boroughs who would usually be seen at Imperial College Healthcare Trust or Barts Health Trust, along with a rise in referrals from Kent and Sussex.

In a statement, the £1.5bn-turnover trust said the discussions with commissioners were ongoing, “so it is not possible to provide details of the potential restrictions”.

The trust also noted in its board papers that the way some cancer pathways were organised between it and other providers needed “radical change”.

In a statement, the trust said it was referring principally to dermatology and urology services, which are both high volume specialties.

A spokeswoman said: “A number of hospital sites within the south east London Accountable Cancer Network are facing sustainability challenges which are mainly regarding maintaining sustainable staffing levels to support increasing demand on cancer services.

“To address these issues, clinical teams across the network are working together to develop new models of care for dermatology, urology and diagnostic services, which will ensure local services are resilient.”

Last month, King’s College Hospital FT reported it was considering restricting urology cancer referrals for out-of-area patients, as it struggled with its diagnostics workload.