Thousands of patients are being denied access to hospital consultants because the NHS has set up money-saving management schemes which block GPs' referrals.
In direct contradiction to the government's claims to be encouraging more choice in healthcare, patients with rheumatoid arthritis, knee problems and eye and skin conditions are being targeted by managers who intercept referral letters and send them back to GPs or into physiotherapy clinics rather than allowing them to be seen by the appropriate specialist.
The scale of the interference has led some GPs to use extraordinary subterfuges to get their patients to a surgeon. One practice in Merseyside has decided to send letters marked 'private and confidential' to the surgeons when they need a referral, rather than using the usual computer system which would automatically block the request.
Another doctor told The Observer that he uses handwritten letters to hospitals outside his area which he knows will not be blocked from taking patients.
As the NHS struggles to deal with £620m of debt, administrators are using referral management schemes to curb hospital admissions and to cut waiting lists. The schemes start to operate once a GP sends an electronic letter to a hospital consultant, requesting an appointment for the patient.
The letter is scanned by administrators who decide whether it constitutes an 'appropriate' referral. If they deem it unnecessary, the patient is 'bounced' back to a clinic within the primary care trust, or to a nurse manager or a physiotherapy clinic if it is an orthopaedic problem.
The British Medical Association has warned ministers that the plans are threatening the relationship between a GP and patients, and that this goes against the choice agenda even though the government is adamant that the schemes can save millions of pounds.
Angry GPs in Merseyside are faxing referrals directly to a consultant to stop managers intercepting them. They are also posting letters marked 'private and confidential' to prevent hospital staff from opening them, and pushing patients back into the GP clinics. Doctors at a practice in St Helens said they were forced to take the action after patients they had referred for orthopaedic, rheumatology and physiotherapy were being diverted away from Whiston Hospital in Prescot to a physiotherapy clinic.
A family doctor in Hertfordshire said that he had started to send orthopaedic patients to a hospital outside their local area, so that he knows they will see a surgeon. Dr Gerry Bulger is upset that his local body, Dacorum primary care trust, set up a system which means that patients with rheumatoid arthritis or orthopaedic problems cannot get an appointment with a consultant; instead they are sent to see a physiotherapist or another GP, who then decides what to do.
Dr Bulger said: 'Sometimes I write a hand-written letter to a hospital which I know will accept them, to get round the diktat. How can the government talk about giving patients choice when they are not allowed in at the front door?'
Evidence from almost 100 PCTs found huge variations in the way GP referrals are being handled, with some trusts using the centres to cut up to 15 per cent of referrals. Orthopaedics, dermatology and physiotherapy were the disciplines where referral management was most prevalent. As a result, almost half the country's dermatology departments are suffering from a huge loss of workload and some may have to close, as patients are siphoned back into GP clinics.
Dr Jonathan Field, consultant leader for the BMA, said: 'Some of the referrals from one consultant to another in the same hospital are now being blocked, which is dangerous because it introduces really long delays.'
In north London, all outpatient follow-up appointments are being stopped unless the patient has cancer and GPs will be expected to check on patients. All referrals for skin conditions are being banned unless GPs stress it is urgent.
Enfield primary care trust is bringing in the measures in the next two weeks to save £5.5m. Every referral to a hospital specialist is now being screened by a panel of GPs, clinicians and hospital specialists under a referral management system known as the Specialist Clinical Assessment Service. A spokeswoman for Enfield primary care trust said the changes are in line with government policy to encourage patients to be treated in primary care near their homes.
A spokesperson for the Department of Health said: 'Referral management schemes should ensure NHS patients see the most appropriate clinician in the most convenient setting. These schemes must only be set up where they will benefit patients.'
