The NHS is introducing a new form of healthcare rationing by weeding out patients from hospital waiting lists who could be treated more cheaply by local GPs.
A scheme to veto "unnecessary" outpatient appointments was introduced in April at Hammersmith hospital in London and is about to be extended to other NHS trusts. It challenges the well-established right of consultants to refer patients to colleagues with appropriate skills.
The approach was condemned last night by Hammersmith hospital's leading consultant in emergency medicine as "straightforward rationing" that could lead to "clinical disasters".
The vetting scheme - disclosed today by Hospital Doctor magazine - was established by Hammersmith and Fulham primary care trust as part of an effort to eliminate the biggest budget deficit in England. The trust set up a panel of GPs and retired GPs to decide whether outpatient appointments are strictly necessary.
The panel looks only at referrals by hospital doctors, including A&E consultants who discharged patients on condition they returned for an outpatient consultation.
The trust said it expected to divert about 30% of patients to GPs, helping people to avoid the need for a hospital visit and saving £695,000 this year.
Kevin O'Kane, director of emergency medicine at Hammersmith hospital, said: "We don't think it is clinically safe. We are concerned about potential clinical disasters."
Dr O'Kane said the trust's "outpatient prior approval panel" was overruling experienced hospital consultants who deemed further assessment by a specialist necessary. The panel does this without seeing the patient.
A spokesman for the trust said: "We believe patients are currently being inappropriately asked to go to hospital when the care they need is available in primary care ... This is about making sure patients get the care they need in the most appropriate place."
A Department of Health spokeswoman said: "Many referrals for more specialist care - whether by GPs or by specialists - are inappropriate ... Care more traditionally provided in hospital can now be provided in settings more convenient for patients. Other local health economies are adopting similar schemes to help patients get the treatment they need sooner and, for many, more conveniently."
