Exclusive: GPs fight for patient care as treatment requests are denied

GPs are increasingly having to fight to provide the care their patients need, as CCGs clamp down on approvals for treatment funding requests.

Less than half (40%) of individual funding requests (IFRs) by GPs in 2013/14 were approved for funding, a GP investigation has revealed – a sharp drop from previous years.

But a decline in the total number of IFRs – the first in five years – could be a sign that CCGs have proved better than their predecessor PCTs at providing access to the services GPs need to refer patients for.

GPs make IFRs on behalf of individual patients to gain access to treatments that CCGs deem non-urgent or of low clinical value.

Responses from 180 CCGs obtained under the Freedom of Information Act suggest about 58,000 IFRs were made in 2013/14, down 32% from 2011/12 according to data from previous GP investigations.

Map: find out how your area treats IFRs

But the proportion of requests approved has dropped substantially, from 55% in 2011/12 to 40% for 2013/14, a drop of 27% in two years.

Five years ago, in 2008/9, 59% of requests were accepted, showing approval rates are steadily decreasing.

But 2013/14 is the first year to see a drop in the number of requests, after year-on-year increases observed over the past five years.

Wessex LMCs chief executive Dr Nigel Watson said this could be a sign of CCGs tightening their belts.

‘I think, as the NHS budget has been made tighter and tighter, they’re potentially less willing to let things through and the processes for approving them become much more rigorous,’ he told GP.

IFR process 'bureaucratic'

GPC chairman Dr Chaand Nagpaul said ‘the whole process of IFR is bureaucratic and costly’. But, although it was ‘impossible to be sure’, he said the fall in requests could be a cause for optimism.

‘I would hope this is a reflection of CCGs ensuring treatments are available where local populations need them to avoid the need for IFRs,’ he said.

Dr Watson said this could partly be the case in his area. In Wessex, services for autism and adult ADHD assessments have recently been put in place, so GPs in the area no longer have to make IFRs on behalf of patients to provide these services.

But, according to GP’s investigation, requests for adult ADHD assessments were among the 10 most requested procedures during 2013/14, suggesting IFRs are the only way GPs can provide these services in many areas.

Dr Nagpaul warned that ‘it would not be right to have a postcode lottery of NHS services’.

The most common requests overall were for cosmetic procedures, IVF, drugs, plastic surgery and breast surgery.

Variation in approval rate

There was also wide variation in the proportion of requests approved across the country, with some CCGs approving up to 83% of requests and many, less than 10%.

Dr Jane Lothian, Northumberland LMC secretary, said the IFR system was ‘pretty fair and evidence-based’ in her area. ‘We have a good, open system, so it’s very clear when you’re referring people. Of course, there’s always going to be that grey area.’

Julian Sturdy, Conservative MP for York Outer, warned in a recent Westminster debate that patients with rare conditions were being unfairly denied treatment despite GPs’ efforts to source appropriate care for them through IFRs.

He told MPs: ‘The IFR process is an extremely difficult task for already busy GPs. It also results in an extremely tragic situation, where a small group of people who suffer with a rare condition slip through the net and do not receive the treatment their doctors feel they need.’

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