According to a recent BBC investigation, patients are facing significant delays in receiving treatment due to Clinical Commissioning Groups (CCGs)’s growing use of referral management centres.
Referral management centres were introduced in approximately 2003 and were designed to reduce NHS spending by vetting GP referrals and deciding if the patients referred should receive hospital treatment. Since 2005 there has been a tenfold increase in the use of referral management centres and now 61 of the country’s 209 CCGs say they use a form of referral management centre.
In 2015-2016, of all the referrals processed by referral centres, 84,000 (4%) were rejected. This number is not high, relative to the number of referrals made, however a closer look at the reasons why referrals were returned shows that there was a 13% increase in the number of referrals rejected for administrative rather than clinical reasons between 2013-14 and 2015-2016, for example the forms being completed incorrectly.
MPs in North Durham have complained about a referral centre which is paid £10 for every referral letter it blocks, and the British Medical Association (BMA) has called referral management centres "inefficient" and a "block between the GP and patient treatment". Dr Chaand Nagpaul from the BMA describes the centres as “a blunt instrument” and that "performance seems to be related to blocking referrals rather than patient care".
Now, GPs are warning of the risks referral centres potentially pose to patient safety. One GP claimed that cancer diagnoses were being delayed because of the extra bureaucracy caused by the referral management centres. He said that the system is “dangerous” and described an incident when a patient referral to a dermatologist “was rejected by the referral management system. It turned out to be a cancer… That was a disaster."
However, Dr Graham Jackson from NHS Clinical Commissioners said referral management centres can "provide a useful and effective role".
Arran Macleod, a solicitor in the clinical negligence team at Penningtons Manches LLP, said: “There is clearly some concern that the use of referral management centres is putting the health and safety of patients at risk. We act for a number of patients who have experienced a far worse clinical outcome because a delay in the course of their care caused them to receive treatment later than they should have done. Our experience tells us that a delay does not have to be large to have an impact on the patient. Therefore, any delay in treatment which has been caused by a GP referral being rejected could have a profound impact on the treatment options available, and the clinical outcome, for the patient. If it is correct that referral centres are paid £10 for every referral that is rejected, there is suggestion that rejecting referrals is being prioritised over patient safety. We welcome any investigations that may reveal such incentives which may put patient safety at risk.
“If you or a family member have experienced a situation where your GP referral was delayed before it was received by the hospital, we would be happy to discuss your options with you and assess whether you may have a claim for compensation.”