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GPs still unable to refer patients to secondary care despite national guidance

GPs still unable to refer patients to secondary care despite national guidance
By Costanza Pearce Reporter
7 May 2020

GPs are being told to hold off referring patients to secondary care against national guidance, Healthcare Leader’s sister publication, Pulse, has learned.

After GPs were told by NHS England to continue referring patients to secondary care on 17 April, NHS Mid and South Essex CCG sent an email to practices saying that they should continue to follow local guidance and hold any non-urgent referrals.

A spokesperson for the CCG told Pulse that it is currently working to agree how to ‘reset elective care in line with national guidance’.

And an email update sent to practices on Friday said that the CCG is working with hospitals to review its position on ‘keeping referrals with the GP’.

However, GPs have raised concerns that they are still not able to make routine referrals and are thus ‘holding all the risk’ for paused treatment in primary care. NHS England told GPs last month that they should continue referring to secondary care on the understanding that hospitals ‘accept and hold clinical responsibility for GP referrals’ during the Covid-19 pandemic.

Specialists would be told to advise GPs ‘in a timely fashion’, NHS England added.

However, NHS Mid and South Essex CCG told local GPs to continue ‘holding outpatient referrals’ despite the advice.

In an email seen by Pulse, Mid and South Essex CCG said: ‘Whilst we recognise that there was a message in the national primary care broadcast webinar last Thursday that acute trusts would be expected to hold non-urgent referrals, this change is still pending national guidelines across acute and primary care. This is expected shortly and will be implemented.’

‘While we are waiting for these national guidelines, practices should continue to follow the existing local guidance on holding outpatient referrals. You will be aware that Mid and South Essex Hospital Group are no longer accepting non-urgent referrals as part of the management of outpatient care in response to Covid-19 pandemic.’

In a letter to all parts of the health service last week, NHS England chief executive Simon Stevens said that cancer ‘referrals, diagnostics (including direct access diagnostics available to GPs) and treatment must be brought back to pre-pandemic levels at the earliest opportunity’.

The letter added that hospitals should take ‘urgent action’ to restore referrals and GP access to diagnostics within the next six weeks.

One mid-Essex GP told Pulse that little has changed, with ‘still no referral option’ available for GPs in the area and access to guidance ‘very patchy’.

The GP, who wished to remain anonymous, said: ’Advice and guidance are very patchy depending on speciality. I just had gastro ones sent back from December 2019 – unable to answer due to pandemic!’

Only ‘life and limb’ referrals are being accepted, while only ‘urgent’ blood tests are available at the community hospital 30 minutes away and none at all are available at the main hospital, they added.

They said: ‘I’m frustrated that we are being told it is available and  “business as usual” but, at least locally, that doesn’t seem to be the case.

‘We seem to be holding all the risk in primary care currently.’

A spokesperson for the five Mid and South Essex CCGs said: ‘Patient safety remains our top priority and we are working closely with the trust and other partners to agree how we reset elective care in line with national guidance. Meanwhile, the trust is running telephone or video consultations for patients, who are brought in if assessed as needing to be, and working with us to improve advice and guidance access.’

A bulletin sent to practices on Friday added: ‘We are working with the Mid and South Essex University Hospitals Group re. keeping referrals with the GP – this is under review as we seek to implement the requirements of the Simon Stevens letter looking at the second phase of the Covid response.’

Other GPs took to Twitter to express their concerns that referrals were still not available despite NHS England’s guidance.

Dr Steve Kell, GP partner at Larwood Health Partnership in Worksop, tweeted that he can’t refer patients yet and that the referral list was ‘building up’.

Swindon GP Dr Gavin Jamie said the local hospital was not accepting referrals due to staff redeployment.

While in Yorkshire GPs were also asked to hold referrals in the practice.

It comes as Monday’s NHS England email bulletin urged all providers to ensure that GPs can make both urgent and routine referrals ‘as normal’ and via the NHS e-referral service ‘as soon as possible’.

It said: ‘NHS chief operating officer Amanda Pritchard has urged all providers to ensure that services remain available on e-RS to allow GPs and other healthcare professionals to make referrals using the NHS e-referral Service (e-RS) and make two-week wait cancer, urgent and routine referrals as normal.

‘Secondary care providers should review this guidance and ensure that the most appropriate features are enabled as soon as possible.’

Meanwhile, NHS England’s primary care lead said in a live webinar two weeks ago that practices whose referrals are rejected should escalate the issue to their commissioner and urged GPs to ‘please keep referring’.

Dr Nikki Kanani said: ‘We cannot be in a position where referrals are being rejected. I know some of you are already saying that is happening, please do escalate that to your CCG if you are able or raise it as an alert and we will be working with secondary care to make sure these referrals are taken.’

Last week, a study revealed that cancer deaths could rise by a fifth due to the pandemic, with urgent cancer referrals down by 76%.

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