London 'rationing' scheme will hit GP workload and patient care, BMA fears

Proposals that could tighten GP referral criteria across London look like a 'cover for rationing', GP leaders have warned.

GP referral (Photo: JH Lancy)
GP referral (Photo: JH Lancy)

Plans set out by the Healthy London Partnership - which advises CCGs and providers across the capital - could raise the bar for access to a range of essential treatments. GPs will be required to prove that patients face 'a substantial impact on quality of life' to refer them for surgery.

The proposals come as part of a review of eight surgical procedures, which aims to standardise surgery referrals across London’s 32 CCGs. The full list of procedures covers:

  • Surgical removal of benign skin lesions
  • Hip replacement
  • Knee replacement
  • Knee arthroscopy (keyhole surgery)
  • Interventional treatments for back pain
  • Varicose vein procedures
  • Shoulder decompression
  • Cataract surgery

GP consultation

The ‘London Choosing Wisely’ review is giving GPs just two weeks to provide feedback on the plans for each procedure - a timeframe that BMA London regional council chair Gary Marlowe says is not enough to allow doctors to provide adequate clinical input.

‘This brief window of consultation does not allow for the necessary engagement and clinical input to ensure the best possible outcome and reduced risks to patient safety,’ he warned.

‘People expecting key interventions such as hip surgery will be adversely affected, and it’s unfair that they could be denied treatment ordinarily available elsewhere.

‘Given the current pressures on GP practices, the additional workload and demand, particularly in GP referrals, these changes could add an additional layer of bureaucracy at a time when resources are in short supply.’

Rationing fears

Tower Hamlets GP Jackie Applebee said the review process ‘looks like another cover for rationing’ and feared it would create even more delays within the referral system.

She told GPonline: ‘I’m concerned it’s going to get harder for patients to get the care they need, it’s going to create delays in the system as well if we have to jump through more bureaucratic hoops and it’s going to increase our workload.

‘At the moment if we decide that a patient needs to be referred on we just do their e-referral and that’s it. If we’re going to be having to tick boxes to say this, that and the other has happened or if we have to go on to another application to justify our decisions to a committee, it just gives us another layer of bureaucracy that we really don’t need.’

Regional medical director for NHS England London Dr Vin Diwakar said that CCG governing bodies would make the final decision about how the proposals were implemented.

A spokesperson for the 'London Choosing Wisely' programme management team told GPonline:

'The London Choosing Wisely programme is advisory and the statutory duty for approval of London-wide policies rests with each CCG governing body who will have the opportunity to consult and debate the draft policies further, before making a decision.'

They argued that the draft policies 'would not, if implemented, add significant workload or bureaucracy for general practitioners in London'.

The Health London Partnership website says: 'The development of a London policy for each treatment will reduce variation of care for all Londoners by ensuring a consistent approach to implementing NICE guidance.'

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