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Increasing numbers of elective referrals rejected outright, Javid told


By Jess Hacker
7 December 2021

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GPs are seeing an increasing number of referrals to secondary care being rejected ‘at the outset’, health secretary Sajid Javid has been told.

In an open letter addressed to the secretary of state, the Doctors’ Association UK GP committee stated that the ‘lack of access’ to secondary care referral pathways is putting huge undue pressure on primary care’.

The latest NHS data indicates that 5.8 million patients were waiting to start treatment at the end of September 2021, with 300,566 of them waiting more than 52 weeks.

The DAUK said GPs are seeing ‘an increasing amount of referrals rejected at the outset’, which causes ‘huge concern’ for patient safety, and often leaves GPs with ‘nowhere to go’ with their patients’ care.

The letter, which was also signed by Doctors for the NHS, GP Survival and 999 Call for the NHS, suggested patients were contacting GPs rather than specialists with problems, such as access to pain relief while they are waiting for treatment.

The DHSC has been contacted for comment.

Two-tier healthcare

The DAUK GP committee added that the health secretary should ‘halt all moves to mandate’ advice and guidance (A&G) services, which provide primary care access to specialist clinical advice.

A&G is a facet of NHSE’s National Elective Care Recovery and Transformation Programme, intended to strengthen shared decision making and avoid unnecessary outpatient activity.

The DAUK said: ‘A&G is a brilliant tool if there is a query over patient care, or some concern over whether a referral is appropriate.

‘However, as GPs, if we have decided a referral is necessary, and the situation is outside our competency then we must refer onwards, in line with GMC advice.’

They claimed that allowing specialists who have not assessed the patient to make the decision as to whether a referral is justified is ‘not in keeping with the current emphasis on face-to-face consultations’ and risks patient safety.

The lack of access to secondary care and the increased rationing of specialist opinions is ‘leading to a two-tier healthcare’ system, in which the NHS is ‘available’ for acute emergencies and cancer care but pushes patients to private care for many common conditions.

13,000 operations cancelled in UK hospitals

It comes as new data revealed more than 13,000 elective care operations were cancelled in November and October this year.

Published by the Royal College of Emergency medicine today (7 December), the dataset showed that nearly 7,000 operations were cancelled at reporting sites in November alone.

It also revealed that 20,169 patients spent 12 hours or more in an emergency department from time of arrival, equal to 7.3% of attendances.

Commenting on the figures, Matthew Taylor, chief executive of the NHS Confederation, said health leaders are clear that plans to tackle the waiting list ‘should include a plan for ‘making sure appropriate arrangements are in place so that those who are medically fit can be discharged from hospital without delay’.

A survey undertaken in the summer revealed that nearly three-quarters (73%) of trust leaders were concerned that plans to address the care backlog will be disrupted over the winter given the need to prioritise urgent demand.

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