GPs and patient groups are concerned about a possible new strategy that would prevent GPs from being able to make direct referrals to NHS specialists.
Instead, the so-called “advice and guidance” approach would require GPs to first discuss a patient’s case with a hospital consultant before making a referral.
Family doctors often refer for specialized care when a patient has specific symptoms, such as a suspicious mole or an unusual reading on a blood test, that requires a more detailed medical examination.
The advice and guidance policy is already in use in some parts of England, but NHS leaders are considering rolling it out nationally. A final decision will be made in a national outpatient strategy to be published in December.
Fans of the model argue that it can help reduce the number of unnecessary referrals, saving time for both the patient and the NHS.
However, GPs fear the system could be used to create an “artificial barrier” to prevent NHS waiting lists from growing further, adding more paperwork to overworked GPs and “preventing patients receive the care they need.
GPs and patient groups are concerned about a possible new strategy that would prevent GPs from making direct referrals to NHS specialists (file image)
Professor Kamila Hawthorne, president of the Royal College of General Practitioners (RCGP), told MailOnline that GPs were concerned about the model.
“In our ongoing discussions with NHS England about a national outpatient strategy, we have expressed concern about any proposal that insists that all referrals to GPs must be made through the ‘advice’ system. and guidance,” he said.
Professor Hawthorne said GPs already using advice and guidance had provided conflicting feedback on how it was implemented.
She said: ‘We have seen disparities by region, and some of our GPs say that, when properly resourced and implemented well, it is a useful tool to increase communications with their colleagues in the rest of the system.
‘In others, it appears to be used as a barrier to artificially protect waiting lists and prevent patients from receiving the care they need.
“This can have a significant impact on GPs, who are already overworked, and are facing the effect of increased numbers of referrals being delayed or refused.”
Professor Hawthorne added that the RCGP fully supported a closer relationship between primary and secondary care, but that patient care came first.
“The term ‘advice and guidance’ should only be used to do what the name suggests: provide advice and guidance rather than act as a barrier to timely referrals of patients,” he said.
Patient advocacy groups are also wary of what advice and guidance might mean regarding wait times.
Dennis Reed, director of Silver Voices, which campaigns for older Britons, told this website this was “concerning”.
“It seems like another way to ration patients,” he said.
“It’s putting an extra bureaucratic barrier to referring people to consultants.”
He added that he imagined such a policy could add “a couple of weeks” to patients successfully getting the GP referral they needed.
“The concern is that there will be a back-and-forth in correspondence between the GP and the hospital consultant,” he said.
Reed also criticized the policy of infantilizing family doctors.
“It also calls into question the professional competence of GPs, who are basically saying, ‘It’s up to us to decide whether this person’s referral is correct or not,'” he said.
He Health Services Journal It reported that health leaders are considering significantly increasing the use of advice and guidance in England.
The latest GP workforce data for May 2023 shows there are 27,200 fully qualified GPs in England. This is down from 27,627 the previous year. The number of GPs peaked at 29,537 in March 2016
They cited NHS data showing that when the system was implemented it prevented 70,000 referrals to GPs, and consultants determined they were not necessary.
On the possible plan to disseminate advice and guidance more widely, an NHS spokesperson said the health body is “still seeking views on the proposals”.
They added: “In reality, the NHS is making it easier for people to get specialist advice, whether by giving GPs the power to order diagnostic scans to detect cancer without needing a hospital appointment, or hospital consultants joining weekly meetings with family doctors to talk about patients.
A spokesperson for the Royal College of Physicians, one of the groups consulting with NHS England on the outpatient strategy, said: “We are delighted to be working with doctors, patients, managers, healthcare leaders and providers at all levels to achieve this. “.
‘Basically, we all agree that we need this integrated approach and any recommendations, once fully developed, will need to address any impacts across all sectors to improve patient care.
‘The advice and guidance model is not new, so it is already part of what GPs and specialists do.
“Ideally, communication between GP, specialist and patient could accelerate care, with early advice and transfer to a planned specialist care pathway when necessary.”
A Department of Health and Social Care spokesperson said: “Cutting waiting lists is a top priority for this Government and transforming outpatient services is key to ensuring people can get the care they need, when they need it.”
‘Providing GPs with access to advice and guidance supports faster diagnosis and treatment and ensures patients receive the right type of support in the right care environment.
“If a patient needs to be seen by a specialist, specialist advice makes it possible to identify the right doctor at an earlier stage in the process, making better use of the time spent at the appointment.”