GPs praised for dramatic fall in unnecessary referrals
pharmafile | January 31, 2007 | News story | |Â Â Â
The government has hailed the success of one of its key reforms, practice-based commissioning, saying it has helped some areas cut unnecessary referrals by as much as a quarter.
Many patients currently have to wait long periods to see specialists in secondary care after being referred by their GPs, even though their condition could be treated more quickly outside hospital if services were re-configured.
Reducing the number of unnecessary referrals will cut waiting times and, the government hopes, save the NHS money, and England's pioneering general practices have now been praised for cutting referrals.
The government is keen to promote practice-based commissioning (PBC) to England's GPs and their practice staff, but many have so far failed to take up the chance to engage in the system.
PBC gives practices greater power over how NHS money is spent and the chance to reform services, but many remain unconvinced about the government's motives for championing the idea, some believing it is purely about saving money.
Others, however have embraced the system, and seem to have had remarkable results.
The government says if all GPs matched the 25% drop in referrals achieved by the pioneers, it would mean around 2.5 million patients a year would receive care in more convenient locations, such as community-based health centres and GP surgeries, rather than traditional large hospitals.
Health Minister Andy Burnham said: "We are seeing promising signs that the NHS is starting to provide more care closer to home. The successful roll-out of our reforms, like practice-based commissioning, will see more patients receive care locally, without the need to go to hospital.
Burnham said PBC would be vital to the NHS achieving the latest tough government-enforced target for no patient to wait more than 18 weeks for treatment by 2008.
"We want to encourage GPs to consider the best course of treatment for their patients, rather than needlessly referring them to hospital. Practice-based commissioning provides this incentive for GPs to think carefully before referring a patient to a consultant."
PBC Case Studies
– Manchester PCT has set up a GP with special interest-led gynaecology service (GPwSI), which is commissioned by the local PBC consortium to triage all referrals into secondary care. The GPwSI currently handles 32% cent of referrals, but the service is expected to expand so that only 30% of current referrals will still be seen in secondary care.
– Kingston Co-operative Initiative – a co-operative set up by all GPs within the London borough is now assessing and managing all patient referrals to hospital. In the first three months of this PBC initiative, GPs in the consortium have cut patient referrals to secondary care by 25 per cent.
"One of the benefits of practice-based commissioning is that those in the best place to make decisions – GPs – are able to make those decisions," said Charles Alessi, Medical Director at the co-operative. "Our co-operative has introduced secondary services into clinics whereby patients with long-term conditions, such as diabetes, can be treated within our community by GPs with a special interest. "All GPs have contributed their skills and knowledge on how things should be run in the co-operative as practice-based commissioning is rolled out," said Dr Alessi.
Being independent of the PCT provides the co-operative with a number of advantages, including practices being more open to change as PBC is implemented.
