• Advanced nurse practitioner told by OUH it does not accept non-medical referrals
  • But guidance suggests advanced nurse practitioner should be able to make referral
  • Trust says decision to suspend non-medical referrals linked to “rapid increase in applications”

England’s chief nursing officer has said NHS Improvement will be “picking up” issues with an acute trust blocking non-medical referrals, despite national guidance stating they should be accepted. 

Ruth May was responding to concerns raised after an advanced nurse practitioner was told by Oxford University Hospitals Foundation Trust it did not accept non-medical referrals from GP surgeries.

Dean Whiting, lead advanced nurse practitioner for a large GP practice covering Oxfordshire and Buckinghamshire, told HSJ he has been trying to set up non-medical referral rights for his team of advanced practitioners over the last 18 months and said he has been “blocked at every level”.

In an email seen by HSJ, Mr Whiting was told by the radiology clinical unit operations manager at John Radcliffe Hospital, which is run by Oxford University Hospitals FT, that “we do not accept non-medical referrals from the GP surgeries”.

Guidance produced jointly by Royal colleges and supported by The British Institute of Radiology states a non-medical referrer – provided they are a regulated healthcare professional – can work as an autonomous practitioner, as part of a clinical team where they act on a radiology report or after a doctor has done an initial review.

“Advanced practitioners have developed the role and scope of practice over the last 15 years in order to improve the service delivered to patients, and in some areas this has included the development of non-medical referrals to radiology departments,” Mr Whiting said.

“Anecdotal evidence would suggest that this is rare and most practitioners struggle to engage with and gain referral rights from imaging departments,” he added.

In response, an Oxford University Hospitals FT spokeswoman said the trust has temporarily stopped processing applications for non-medical referrers from outside the trust “to remain compliant”, as there has recently been “a rapid increase in applications to request image referral rights”, which the trust was investigating. 

“Regulations require us to individually authorise all non-medical referrers to our radiology department,” the spokeswoman said.

The spokeswoman added the trust has “long accepted and embraced referrals from non-medical practitioners” and it would continue to do so.

However, Alison Leary, professor of healthcare and workforce modelling at London South Bank University, said declining referrals from a non-physician is “something we hear about very often”, with trusts giving a variety of reasons.

“I think it’s because they are concerned there will be a surge in demand,” Professor Leary said.

She added a failure to accept non-medical referrals was “certainly very likely to delay care” and “is a patient safety issue”.

NHS England was asked specifically about the issue but did not provide a substantive response to HSJ’s questions.