One issue that was raised more frequently than any other was referrals. Complex referral forms and protocols, extra work-up of patients before they are even 'allowed' to be referred and referrals being inappropriately 'bounced' to community clinics were all creating more work.
But two issues: GPs having to see and re-refer patients who fail to attend their initial outpatient appointment, and local 'bans' on consultant-to-consultant referrals, were mentioned most frequently.
This week's front page uncovers the scale of this problem and, where it happens, it places a huge amount of extra work on general practice, none of which is funded.
GPs accept the need to refer appropriately and scrutiny of referrals has been part of general practice for some years. But to ensure effective referrals, which will allow the NHS to make the best use of its resources, both sides of the system (referrer and provider) must be looked at. Too often the focus is on the referrer, but providers play a crucial part.
The problems GP highlights this week create inefficiencies in the system. Surely it is quicker and cheaper for the outpatient clinic to contact non-attending patients rather than them taking up another GP appointment? Why should GPs be expected to absorb this extra work? Barring consultant-to-consultant referrals not only creates more work, it is annoying for patients and potentially leads to delays.
As CCGs take control of budgets they will inevitably see referrals as an area where they can control costs. The challenge will be managing referrals without placing undue pressure, and extra unfunded work, on general practice. Hospitals must take on their share of this work rather than expecting GPs to pick up the pieces.
The key to this will be better integration, improved communication and a more joined-up approach between primary and secondary care.