Is patient safety being put at risk due to NHS England's drive to cut costs?

18th September 2017 Clinical Negligence

Last week, a leaked NHS England memo revealed that Clinical Commissioning Groups (CCGs) are being instructed to review GP referrals and ensure 'Clinical Peer Groups' are in place in a bid to cut referral numbers by up to 30%. In essence, GPs are being urged to seek second opinion before making a decision to refer their patients to hospital. In return, the CCGs who establish GP peer review schemes by September 2017 are promised 'significant additional funding'.

Pulse, a specialist publication for doctors, reported the leak last week[1]. They quoted from the email sent by NHS England, which said, 'significant additional funding is being given to regional teams in 2017/18 .. that will help CCGs to deliver a slower growth in referrals.'

These plans worry me. It has been reported that areas such as Luton have already seen an 8% drop in hospital referrals as a result of peer review systems. In my view, the plan to slow down referrals and cut the number of people being sent to hospital does not sit easy with the concept of patient safety.

What more, from experience working in the clinical negligence team at JMW, I know it is already very difficult for some patients to get a referral from their GP. Indeed, The National Cancer Patient Experience Survey 2015, which examined the experiences of more than 71,000 cancer patients, found that 24% of patients had to see their GP at least three times before being referred to hospital. At JMW, we act for a number of client's who have suffered a delay in diagnosis of their cancer because a referral has not been made and sadly, often for them, it has come too late.

NHS England has said that 'clinical peer reviews are a simple way for GPs to support each other and help patients get the best care, from the right person, at the right time without having to make unnecessary trips to hospital.'

It seems several practitioners do not agree, and some have expressed concern that referral management schemes can result in delayed referrals. There is also apprehension that with GPs already under a huge amount of pressure, the schemes will simply become a tick-box exercise, rather than something that will improve patient outcomes and NHS efficiency.

Primary Care services are already stretched to their limit, and of course most people would welcome additional funding for CCGs, but is it worth it at the compromise of early diagnosis? And I wonder whether patient safety really is at the forefront of NHS England's mind when implementing such schemes? The last thing we want to see is GPs being discouraged from referring patients who need further investigations or specialist treatment.

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Eddie Jones is a Partner and Head of Department located in Manchesterin our Clinical Negligence department

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