Conference attacks referral centresBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7557.9-a (Published 29 June 2006) Cite this as: BMJ 2006;333:9
Tell us about independent treatment centres’ staff and results, say doctors
Doctors have criticised management referral centres for sending patients for inappropriate treatment to independent sector treatment centres far from their home. At their annual conference in Belfast, BMA representatives backed motions that condemned the use of referral management centres, saying they made a nonsense of patient choice, and called for a restoration of GPs’ right to refer to a named specialist.
Charlie Daniels, a GP in Torquay, said that patients who are referred for whatever reason are in a vulnerable position, because they are worried about what will happen to them. Yet patients in his area are being put under pressure by a management referral centre to switch from being seen at the local district general hospital recommended by their GP to a treatment centre 60 km away in Plymouth.
He recounted the case of a late middle aged woman whom he referred for an arthroscopy at the local hospital. She returned to the surgery seeking advice after the local management referral centre told her that she was scheduled to have a total knee replacement operation in Plymouth. "In that case my GP colleague re-referred the patient back to the district general hospital [for the minor procedure]," said Dr Daniels. "She [the patient] was clearly distressed, and it would have been negligent for a woman of her age to have a knee replacement."
Another case involved a woman in her 80s who had multiple medical problems and who was referred by the management centre for treatment at the Plymouth centre rather than the district hospital, which was better equipped to care for her, said Dr Daniels.
The treatment centre in Plymouth, which has been running for 18 months, is one of an estimated 30 to 40 such independent centres in England.
Andrew Mowat, a GP in Lincoln, said, "This [the work of management referral centres] is political interference in the doctor-patient relationship and must be stopped." He too recounted cases of inappropriate referrals through management centres. In one case a 34 year old man whom he referred to the surgeon who had operated on his spine six years earlier was instead seen by a physiotherapist. The patient was later referred to a surgeon with no expertise in spinal surgery and then put on a tertiary waiting list to see a spinal specialist. "They [referral management centres] do not add any value. What they do do is allow patients to be fobbed off to non-doctors to save money."
"I and my patients want choice, but that is not case when you are referred by a management centre 30 miles down the road," Dr Daniels told delegates. "I do not know the surgeons at the independent treatment centre, what their specialties are, or what qualifications they have. But I have confidence in my district general hospital."
However, Pauline Brimblecombe, a Cambridge GP with a special interest since 2000 and who has had access to GPs’ referral letters, defended referrals centres. "I read a lot of doctors’ referral letters, and they [patients] do not all need a secondary opinion. In a cost rationed system there is enormous cost, and many referrals could be prevented," she told the conference.
Although Dr Daniels said he was not against the idea of increasing NHS capacity through independent treatment centres, he called for more information about the centres, who staffed them, and how their results compared with those of local hospitals.
Independent treatment centres are working well below their capacity, said the BMA’s chairman, James Johnson, but they are paid for the number of operations they have been commissioned to perform whether they do them or not. "At the same time the NHS has very severe problems—laying off staff in large numbers because they cannot afford to keep them. We can understand why doctors are getting angry," he said.
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