BMA meeting: GPs are being told to limit their hospital referrals, meeting hears

Cuts in funding are squeezing the NHS, leading to operations being deferred, to postcode lotteries of care, and to unfilled vacancies in hospital staffing, the Annual Representative Meeting of the BMA heard this week.

In a series of debates, doctors drew attention to the many ways in which a flat budget in cash terms translates into a declining one in service terms. The most stirring speech came from Gillian Beck, a Buckinghamshire GP who said that she was now limited to four and a half referrals a week, including urgent ones.

She took representatives through a typical week. By the time Friday came, she was down to her last half referral when a patient appeared with hearing loss. “I wondered if I could use up my last half referral by getting one of his ears checked” she said, to laughter.

She said it was unacceptable that referral managers should use confidential patient information to determine whether referrals should go through, and where patients should be sent. “GPs aim to send the right patients to the right people at the right times” she said. “Primary Care Trusts are masquerading behind triage in order to manage budgets.”

Michael Ingram, a GP from Hertfordshire, went further, calling it “evil” that in his primary care trust, patients who smoke are not allowed orthopaedic referrals for operations they need unless they first agree to attend smoking-cessation sessions. “This is just a way of saving money” he said. “Patients suffer unnecessarily as a result.”

The motion rejecting the use of referral centres was passed overwhelmingly, as was a motion rejecting the requirement that NHS trusts should be required to balance their books at the end of each financial year.

Louise Irvine, a GP from Lewisham, south east London, said that in many NHS organisations financial imperatives had eclipsed clinical ones. “It is causing a distortion in care,” she said. “Nursing cover is dangerously low and treatments are being deferred. Those in financial difficulty should be supported with continuing funding, not forced to meet artificial financial deadlines.”

She was backed by Chaand Nagpaul, a GP from Edgware and a member of the BMA Council, who said that near the end of the financial year some primary care trusts simply declined to allow any elective referrals at all. “If you need a cataract operation, get referred in April,” he advised. “If your vision fails in October, you won’t be referred. It’s unethical, and it’s not even saving money, just stockpiling patients for the next financial year.”

Pleas from Jonathan Fielden, Medical Director of the Royal Berkshire NHS Foundation Trust and also a member of council, that doctors should live in the real world and that condemning the rules on achieving year end financial balance missed the point, went unheard. With the approval of Hamish Meldrum, chairman of council, who called the rules “knee-jerk short-termism,” the motion was carried overwhelmingly.

In a similar vein, Dr Nagpaul successfully proposed a motion deploring the variation in the definition of “low-priority” treatments in different areas. In north west London, he said, there were 85 low priority procedures ranging from hip replacements to hernias. But the lists varied between primary care trusts, creating a postcode lottery.

“We recognise that the NHS can’t afford unlimited treatments, but the rules should apply universally so that patients aren’t at the mercy of where they live” he said.