Intended for healthcare professionals


GPs put the squeeze on access to hospital care

BMJ 2013; 347 doi: (Published 10 July 2013) Cite this as: BMJ 2013;347:f4351
  1. Gareth Iacobucci
  1. 1BMJ

As GPs take over the lion’s share of the NHS budget, Gareth Iacobucci looks at how they are dealing with the difficult dilemmas of rationing

Clinical commissioning groups (CCGs) in England have begun implementing new restrictions on referrals to secondary care, as evidence emerges of the role that doctors are being forced to play in rationing NHS care, a BMJ investigation has found.

Some CCGs have tightened the thresholds for access to surgery, while others have introduced new referral gateways to restrict the number of patients being sent to hospital—as commissioners strive to manage their resources amid increasing financial restraints. Access to treatment for hernias, cataracts, and musculoskeletal conditions such as trigger finger have all been affected.

The BMJ’s investigation also found that most of the new GP led organisations, which assumed statutory responsibility for commissioning around £60bn (€70bn; $90bn) of NHS care on 1 April 2013, are dragging their feet in implementing new guidelines from the National Institute for Health and Care Excellence (NICE) designed to widen access to in vitro fertilisation (IVF), with only four CCGs having amended their policies so far.

One in seven CCGs in England tightened criteria for referring patients for so called low clinical value treatments in 2013-14. Many more have retained existing restrictions previously put in place by the predecessor organisations, the primary care trusts (PCTs), while others have opted for new triage systems to screen referrals from general practice and restrict the flow of activity towards secondary care.

But a few have removed referral restrictions that existed under PCTs and are relying on more streamlined communication between primary and secondary care doctors to drive down costs, highlighting the contrasting approaches being adopted to tackling the government’s target of achieving £20bn efficiency savings in the NHS in England by 2015.1


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