Questions over private firm ‘interference’ to Durham GPs
NHS bodies are paying millions of pounds to private firms that stop patients being referred to hospital by their GP, an investigation has found.
North Durham Clinical Commissioning Group is among a number of CCGs using the controversial referral management centres to scrutinise patient referrals to hospitals by family doctors.
In October, Durham Labour MP Roberta Blackman-Woods called for action from the Health Minister after hearing North Durham had awarded a contract to private firm About Health to screen referrals for conditions including cardiology, gynaecology and gastroenterology.
Supporters say they can cut down on inappropriate referrals, saving the NHS money, but critics argue that adding an extra layer of scrutiny can risk delaying diagnosis for the patient. There is also a question mark over how effective such schemes are.
In a new investigation, the British Medical Journal (BMJ) sent freedom of information requests to all 211 CCGs in England. Of 184 that responded, 72 said they currently commissioned some form of referral management scheme to help manage outpatient demand at their local hospitals.
Almost a third of the schemes are provided by private companies, while a further 29% are provided in house and 11% by local NHS trusts.
Some 69% of CCGs with schemes gave details of operating costs. These CCGs combined have spent at least £57million on schemes since April 2013.
Most CCGs were unable to provide evidence showing the scheme saved money. Only 14% could show that the scheme had saved more cash than it had cost to operate, while 12% showed that their schemes had not saved money overall.
Meanwhile, 74% of CCGs (53 groups) failed to supply figures to show whether any money had been saved, the BMJ reported.
Dr George Rae, North East chairman of the British Medical Association said: (CCGs) are leaping at these schemes without any clear evidence of benefit and that they're just hopeful that it might reduce their costs.
“It would appear to be the case that this is not something which is saving money. If you’re talking about saving money, ones got to be saving substantive amounts of money if one is trying to plug the financial hole which we’ve got in the national health service.
“All the money that is being used in those schemes could be used for other services for patients as opposed to being given to private companies for scrutiny of referrals then finding that we’re not saving money, it’s a sad state of affairs.”
Graham Jackson, from NHS Clinical Commissioners, the membership organisation which represents CCGs, said referral management was just one way of managing demand for services.
He said: “In many cases they provide a useful and effective role which is more than a redirection service. CCGs will balance the cost of commissioning with the benefit they provide to GPs and patients in terms of peer review, education, caseload management and choice.”
A spokesperson from North Durham CCG said:
“Rapid Specialist Opinion is being put in place to make sure practices follow clinical guidelines which have been agreed locally with GPs, hospital consultants and other relevant practitioners.
“We have involved our patient participation groups, followed clinical guidelines and modelled this from a pilot that has been running in North Tyneside to provide high quality care for our patients so we could refer on appropriately.
“As with all pilot schemes, RSO will be closely monitored and evaluated. If the evaluation suggests the pilot is not effective or providing the benefits anticipated, then the contract will be reviewed.
Further information about RSO can be found on the CCG website. http://www.northdurhamccg.nhs.uk/key-documents/patient-information/