PCTs restrict GP referrals 'waiting for patients to die or go private'

There is a serious risk that PCT behaviour will undermine the possible benefits of the government's Any Qualified Provider policy, a report has warned.

In a review of the operation of the Any Qualified Provider (AQP) policy, previously known as any willing provider, for the provision of routine elective care, the Cooperation and Competition Panel (CCP) found that some commissioners were ‘excessively restricting’ patient choice. 

Daily Telegraph coverage of the report today says that NHS managers are deliberately delaying operations as they wait for patients either to die or go private in order to save money.

It says some managers insisted that longer waiting times would lead to overall savings as 'experience suggests that if patients wait longer then some will remove themselves from the list'. Interpreting this statement, the panel noted: 'We understand that patients will 'remove themselves from the waiting list' either by dying or by paying for their own treatment at private sector providers.'

The CCP said that, although in some cases PCTs were offering sufficient patient choice, there were also some PCTs who were ‘excessively constraining patients’ ability to choose a provider’.  

The report said that a number of PCTs had attempted to constrain patient choice by influencing GPs' referral decisions ‘and in some cases, directing GPs to refer patients to (or away from) certain providers’.

The report warned that patient choice was also being ‘distorted or limited’ by the use of referral management centres.

The report said that some PCTs had attempted to control GPs’ referral decisions by 'providing information to GPs about providers' and 'making recommendations to GPs about which providers patients should be referred to'.

It had also found that PCTs had placed prohibitions on the referral of patients to certain providers and some had put in place additional approval processes where GPs wished to refer patients to a particular provider.

The CCP warned that unless PCT behaviours were addressed, the expected results of AQP, such as higher quality services and better value for money ‘are not going to be realised to their full potential’.

'PCTs influencing referrals is likely to result in at least some patients being treated at a provider that does not best reflect the patient’s preferences,' the report said.  

The CCP warned that a provider 'that knows that it is the beneficiary of PCT actions to influence GP referrals' would not need to try as hard to attract patients and may therefore 'offer a lower quality of service'.

The CCP's recommendations for the DoH:

  • Future commissioners must be required to demonstrate an understanding of the rules concerning patient choice and competition, and a commitment to comply with their obligations under these rules.
  • Commissioners, when imposing waiting time requirements on providers, publish prominently on their website clear information about the minimum waiting time imposed by the PCT on each provider.
  • Commissioners must be required to ensure that referral management centres do not unduly distort patient choice.
  • The DoH reviews the way the market forces factor is incorporated into the tariff for routine elective care, and assesses whether the incentives the current arrangements create for PCTs to restrict patient choice are outweighed by other considerations.

An exclusive investigation by GPonline.com this week found that two-thirds of PCTs were restricting treatment:find the full results here.

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