The NHS is rolling out a scheme that requires all family doctors in England to seek approval from a medical panel for all non-urgent hospital referrals, including hip and knee surgery, cataract removals, X-rays and scans. The “peer review” scheme is being expanded nationwide from next week following a pilot in two regions in the north-east.
Great! That’ll help! It’s not like people already wait far too long as it is…
Is this a good or bad thing? Should we rethink the gatekeeper role of GPs? Will this scheme make it harder than ever to get to see a specialist? Or will it help to streamline the referral process so you get to the right service in a shorter time?
Going on previous NHS track records, what do you think?
Most healthcare in the UK is delivered in primary care. Everyone wanting to access secondary care (usually hospital-based consultant teams) has to go via a GP. Most private health insurance companies require a GP referral too. The only way to bypass GPs is to pay a specialist yourself, and even then most will ask for details from the GP. People who come from countries where primary care isn’t well developed, and where the rich are used to accessing specialists as they would buy any other service, often find this GP gatekeeper idea frustrating and unnecessary.
Yes, they think we’re barmy. And maybe they are right?
The best sort of GP referrals will be asking the specialist a specific question that the generalist can’t answer or requesting access to investigations and treatments that aren’t available in primary care. GPs are usually also good at understanding what’s available locally and signposting you to the appropriate specialist service.
So if GPs are so good at making and directing referrals, why not trust us to send our referrals directly? Why introduce another tier that scrutinises the referrals? Doesn’t that just waste money and cause further delay in an already sluggish system?
All very good questions. Probably the ones anyone reading this article is asking themselves right now.
The conscientious GP will do their utmost to follow guidelines and supply all the necessary information with the initial referral. And if it gets bounced back with a request for more information, will supply it promptly. But GPs vary in quality and efficiency and some referrals that get bounced back languish in in-trays while the patient waits for an appointment, unaware that it is yet to be processed.
Then, identify these GPs and tackle them. Don’t go in for the usual bureaucratic collective punishment!