Rates of ‘routine’ hospital referrals slashed

DRAMATIC reductions in rates of patient referrals for routine hospital care are being delivered in Yorkshire as NHS savings plans begin to bite.

Numbers of patients referred by GPs to hospital soared by 16 per cent in the three months to December 2009 compared to the same period two years earlier.

But only three per cent more patients were referred between October and December last year compared to 2009 and there were even significant reductions in some areas including Sheffield where fewer outpatients were sent to hospital than in 2007.

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Cutting referrals for expensive hospital care is a vital part of an NHS austerity drive to make savings worth £1.6bn in the region in the four years to 2015.

But the reductions have prompted accusations patients are missing out on hospital care to save cash.

A staggering one million referrals are made by GPs for routine outpatient appointments in Yorkshire each year.

Official figures reveal falling numbers of referrals in the last two years in South Yorkshire and northern Lincolnshire and a major slowdown in increasing referral rates in all other areas except Calderdale and North Yorkshire, where high rates of GP referrals have been identified as a key problem in decade-long financial difficulties which saw the county needing £23m in extra funding in 2011-12.

Major differences remain across the region with increases in outpatient referrals of 17 per cent in Bradford and 15 per cent in Leeds in the last two years compared to a 13 per cent fall in Sheffield.

The findings back up national statistics which reveal a drop in outpatient referrals of 2.3 per cent in the nine months to December last year compared to 2010. Early figures show plans to cut referrals in the last 12 months in East Yorkshire and North East Lincolnshire are broadly on track but in North Lincolnshire numbers are 10 per cent higher than expected amid complaints of “unwarranted variations” due to resistance to change among family doctors.

Katherine Murphy, chief executive at the Patients Association, claimed primary care trusts (PCTs) were blocking referrals for some hospital procedures due to financial constraints.

“We have been worried about the complete lack of clarity and information on the issue of how patient referrals are being managed,” she said.

“Decisions on patient care must be made on the basis of clinical need, not on cost.

“We continue to hear more and more from patients that they are struggling to access many treatments and it is completely unacceptable.”

GP Michael Dixon, chairman of the independent NHS Alliance which represents GPs and primary care trust managers, said reduced referrals were being achieved as more patients were being seen in the community for tests and investigations, there was wider use of telemedicine and some GPs were becoming specialists in specific conditions.

“Patients who need to be referred to hospital are being referred but if you use specialist medicine slightly less that comes as a saving to the NHS in these difficult financial times,” he said.

He said as GPs prepared to take over responsibility for NHS spending next year, more innovative ways of treating patients closer to home would be developed.

Figures show numbers of outpatients seen in hospitals in the last two years have fallen at a number of NHS trusts in Yorkshire, one of a number of factors which is putting growing pressure on budgets.

There was a four per cent fall in outpatients seen at the Mid Yorkshire trust, which runs services in Wakefield, Pontefract and Dewsbury, between October and December last year compared to 2009. Other falls were seen over the period at the South Tees trust, which treats patients in Northallerton and Middlesbrough, and the Northern Lincolnshire and Goole, Scarborough and Rotherham trusts.

The reductions are in stark contrast to a boom from 2007-2009 when the Keighley-based Airedale trust saw a 37 per cent increase in outpatient referrals, Sheffield’s adult hospitals dealt with 33 per cent more cases and Leeds saw an extra 25 per cent.

GP Zak McMurray, clinical director at NHS Sheffield, said the PCT had aimed to save £300,000 from its £70m contract with adult hospitals in Sheffield for outpatient appointments in the last 12 months.

No patient was being denied care they required but could be offered care more locally. The development of clinically-led guidelines for referrals and of services within community and GP primary care had ensured patients were seen in the “most appropriate setting for their medical need”.

“This means that more patients are receiving care closer to home rather than being referred to hospital, which can be both inconvenient and unsettling for the patient, clinically unnecessary and also more expensive to the taxpayer,” he said.

Health chiefs in Bradford and Leeds said changes in the population, including increasing numbers of older people, had contributed to the growth of GP referrals to hospital.

Efficiency plans for the next two years reflected the need to reduce hospital admissions and outpatient care “significantly beneath their historic growth levels”.

“We are committed to ensuring the needs of our patients are met and, where appropriate, involve them in deciding the care pathway that would work best for them. Although we actively encourage the use of primary care and community-based settings sometimes a referral to secondary care provides the best treatment option for our patients.”

Extra demand on hospital services was expected in some fields due to the ageing population. It is hoped patients will be referred earlier for treatment for cancers due to speedier detection.

Officials in North Lincolnshire said a “challenging target” to reduce GP referrals to hospital in 2011-12 had not been hit but nevertheless there had been a fall in referrals of around 2.5 per cent.

GP leaders in the area had set up a peer review system to examine where further improvements could be made. “The choice to make a referral to hospital remains a clinical decision based upon the needs of the patient and judgment of the reviewing doctor,” said a spokesman.