Are NHS waits set to get even longer? GPs told to ask before referring patients to hospital despite warning it will prevent Brits ‘getting care they need’

GP and patient groups are concerned about a potential new strategy that would stop family doctors being able to make direct referrals to NHS specialists.

The approach called ‘advice and guidance’ would instead require GPs to first discuss a patient’s case with a hospital consultant before a referral is made.

Family doctors often make such referrals to specialist care when a patient has specific symptoms, such as a suspicious mole or an unusual reading on a blood test, that requires further detailed medical examination.

The advice and guidance policy is already used in some parts of England but NHS leaders are considering rolling it out nationally. A final decision will be made in a national outpatient strategy to be published in December.

Fans of the model argue it can help reduce the number of unnecessary referrals, saving both the patient and the NHS time. 

However, GPs fear the system could be used to create an ‘artificial barrier’ to protect NHS waiting lists from growing even further, add more paperwork to overworked family doctors and ‘prevent patients from getting the care they need’.

Professor Kamila Hawthorne, chair of the Royal College of General Practitioners (RCGP) told MailOnline that GPs had concerns about the model.   

‘In our ongoing discussions with NHS England about a national outpatient strategy, we have voiced concerns about any proposal to insist that all GP referrals must come through the “advice and guidance” system,’ she said. 

Professor Hawthorne said family doctors already using advice and guidance had provided mixed feedback on how it was implemented.

She said: ‘We’ve seen disparities by region, with some of our GPs saying that, when resourced appropriately and implemented well, it is a helpful tool to increase communications with their colleagues in the rest of the system. 

‘In others it seems to be used as a barrier to artificially protect waiting lists and prevent patients getting the care they need. 

‘This can have significant impact on already overworked GPs dealing with the spillover of a greater number of referrals that are delayed or rejected.’

Professor Hawthorne added the RCGP fully supported a closer relationship between primary and secondary care, but patient care came first. 

‘”Advice and guidance” should only be used to do what it’s name suggests provide advice and guidance rather than act as a barrier to timely patient referrals,’ said.

Patient advocacy groups are also wary about what advice and guidance could mean for waiting times.

Dennis Reed, director of Silver Voices, which campaigns for elderly Britons, told this website it was ‘worrying’.

‘It looks like another way of rationing patients,’ he said. 

‘It’s putting an extra bureaucratic barrier in the way of people being referred to consultants.’

He added that he imagined such a policy could add ‘a couple of weeks’ to patients successfully getting the referral their GP though they needed.

‘The worry is that there will be a toing-and-froing of correspondence from the GP to the hospital consultant,’ he said.

Mr Reed also criticised the policy for infantilising family doctors.

‘It also questions the professional competence of GPs, they’re basically saying “it’s up to us to decide whether your referral of this person is right or not”,’ he said. 

The Health Service Journal reported that health leaders are considering significantly increasing the use of the advice and guidance in England. 

They cited NHS data which showed where the system was implemented it prevented 70,000 GP referrals, with consultants determining they were not needed.  

On the potential plan to roll out advice and guidance more widely, an NHS spokesperson said the health was ‘still seeking views on proposals’.

They added: ‘The NHS is actually making it easier for people to get specialist advice whether by giving GPs the power to order diagnostic scans for cancer without the need for a hospital appointment first, or hospital consultants joining weekly meetings with family doctors to discuss patients’ treatment options.’ 

A spokesperson for the Royal College of Physicians, one of groups consulting with NHS England on the outpatient strategy said: ‘We’re pleased to be working with clinicians, patients, managers, health leaders, and providers at every level to do this.’

‘Fundamentally, we are all agreed we need this integrated approach and any recommendations once fully developed will need to address any impact on all sectors to improve care for patients.

‘The Advice and Guidance model is not a new one so is already a part of what GPs and specialists do. 

‘Ideally communication between the GP, the specialist and the patient could speed up care, with early advice and transfer to a planned pathway of specialist care when needed.’

A Department of Health and Social Care spokesperson said: ‘Cutting waiting lists is one of this government’s top priorities and transforming outpatient services is key to ensuring that people can get the care they need, when they need it.

‘Providing GPs with access to advice and guidance supports faster diagnoses and treatment and ensures that patients receive the right kind of support in the right care setting.

‘If a patient does need to be seen by a specialist, specialist advice allows the right clinician to be identified at an earlier stage in the process, making better use of the time spent at the appointment.’