Novel plan to cut hospital referrals

By Nick Triggle
BBC News health reporter

Family doctors say they feel pressurised to refer patients to hospital when it is not necessary. One scheme in south London is aiming to reduce the number of patients being seen in hospital.

GPs sometimes refer patients to hospital when it is not necessary

Among GPs, the stories are legendary.

The patient who came into the surgery with a headache, demanding to see a hospital consultant as he thought he had a brain tumour.

Or the girl who thought a rash was the first signs of skin cancer and asked for a second opinion when the GP told her it was nothing to worry about.

A laughing matter? No. Patients are becoming so sceptical about the advice they get from their family doctor that some are being referred to hospital consultants when there is no need.

A study published last year by the British Medical Journal revealed one in five GP referrals were unnecessary but happened because of patient pressure.

And with secondary care costing more than primary care, the trend is eating into primary care trust budgets.

Croydon PCT, similar to many across the country, spends two thirds of its £330m budget on secondary care.

But it is aiming to reverse the trend with the introduction of a new GP post, called a referrals GP, which will give patients access to a second family doctor if they are not convinced by their own.

Answers

Dr Mabel Aghadiuno will see patients who have been referred by GPs working in the community.

"There is this idea that doctors can provide everything that a patient is looking for.

"They want answers where perhaps there are no answers.

"Patients are becoming consumers. The can get information on the internet and question what doctors are doing. That's not necessarily bad, but sometimes the information they get from the web isn't right."

We want to make sure money is spent efficiently Dr Tim Crayford, of Croydon PCT

With patients becoming more demanding, she said GPs needed to spend more time reassuring them but this is not always possible.

"That is where I come in," she said. "I can give them a second opinion, allay their fears and tell them they will be fine."

Dr Aghadiuno, who has worked as a GP for more than 10 years in Liverpool and Glasgow, said she took the post to make a difference.

"As a GP you do not get time to reflect on what you are doing. I was attracted to the position because I can see things in primary care that I want to change."

Her bosses at Croydon PCT have not set specific targets as such but the aim is clear - reduce the 57,000 hospital referrals each year.

Dr Tim Crayford, the trust's director of public health, said: "We want to make sure money is spent efficiently.

Money

"Hopefully this will free up money to spend elsewhere. For example, we want to put funds into services for people with diabetes to provide gold standard care.

"We want secondary care to be used as sparingly as possible. When it is needed, it will be there, but secondary care sucks up money from primary care."

However, Dr Crayford remained adamant that the referrals would not lead to delays in people getting hospital treatment.

Patients are becoming consumers, says Dr Aghadiuno

"If a GP is going to make a referral, they are going to be certain the patient does not need treatment. We do not want to add to the wait."

The trust is also looking to recruit a GP educator to encourage doctors not to make unnecessary referrals.

The two posts are costing £170,000, including administration costs, to run during a year-long pilot.

It is only be open to a fifth of the 170 GPs in the area but if it proves successful, Croydon PCT is aiming to roll it out across the area.

Dr Crayford said the majority of local doctors are supportive of the scheme.

But others remain less convinced. A spokeswoman for the Patients Association said she was "sceptical" about the scheme.

"There are already plenty of health care professionals people can get advice from - nurses, pharmacists.

"What is needed is more awareness about what is available to patients.

"The majority of practices are not single-handed so patients could get a second opinion from other partners as well."

Despite such reservations, Dr Crayford's enthusiasm for the scheme is undimmed.

"Patients often see a practice as a whole and want a second opinion from an independent source.

"We think this is what we are giving them. It should hopefully make a real difference."