In addition, 40–70 per cent of A&E patients could be referred back to practices under draft SHA plans seen by GP.
The draft ‘Pan London Demand Management Arrangements 06/07’ document sets out ‘key demand-management principles that London SHAs will expect to see in PCT plans’.
The SHA document says PCTs must achieve ‘no growth in hospital activity’, and it calls on trusts to cut referral rates to match the lowest 10 per cent of ‘comparable’ trusts in the country.
It says GPs should refer to a review panel instead of a particular consultant or hospital department. The panel ‘clinically assesses the referrals and passes on as appropriate’.
The document calls for triage teams in A&E to assess all ambulance patients and redirect them back to primary care.
It adds: ‘SHAs should expect to see plans for providing longer primary care practice opening hours (8am–8pm) within GMS contracts to ensure there are alternatives to A&E attendance, and the use of incentives within practice-based commissioning to reduce emergency admissions.’
Around half of PCTs in England are thought to use referral-management schemes, but this is believed to be the first time an SHA has ordered trusts to work in this way.
Londonwide LMCs chief executive and GPC negotiator Dr Stewart Drage said: ‘Arbitrary limits and sending patients back when GPs felt it was alright to refer are unfair.’
Dr Drage also said PCTs were ‘operating these policies now’.
Hillingdon LMC secretary Dr Tony Grewal agreed that forcing PCTs to match low referral rates elsewhere was wrong.
‘Referral rates even in appropriately matched practices vary as much as tenfold, and academics say they are one of the poorest ways to judge GPs’ per- formances,’ he said.
Londonwide LMC secretary for North West London Dr Fay Wilson said SHAs should warn the public about cost-cutting plans. She added GPs would only open later or accept more work if resources followed patients.
A spokesman for the London SHAs, which became a single London SHA this month, was unavailable for comment.