Referral scrutiny an 'attack on professionalism', GPs warn

LMCs have criticised referral management schemes for 'eroding' GPs' professionalism and called for GPs to refuse to co-operate with systems without certain guarantees.

Dr Helena McKeown: scrutiny excessive
Dr Helena McKeown: scrutiny excessive

Representatives rejected schemes that require third-party agreement for non-urgent consultant referrals from GP principals, salaried and locum GPs.

They also backed a separate motion calling for minimum guarantees on referral systems to protect GP autonomy.

GPC member Dr Helena McKeown said she was ‘not prepared to have every plan I agree with a patient scrutinised before I take it to be completed’.

She also rejected the idea of linking quality premium payments to reduced referrals.  ‘This places us and the CCG members in an impossible conflict between professional and contractual responsibilities,’ she said.

Dr McKeown said third-party scrutiny on GP referrals were becoming more common for sessional and locum GPs. ‘Experienced, appraised, updated, revalidated GPs to be treated as second-class GPs,’ she said.

She said GPs must ‘not allow your clinical acumen to be eroded by such referral schemes’. ‘Do not destroy the trust between you and your patients. Do not support the creation of a two-tier GP system,’ she said.

Dr Sonali Kinra from Nottinghamshire said: ‘These people at the referral management scheme do not know our patients like we do.’

She said such schemes were ‘not for the benefit of our patients, but purely a cost-cutting exercise.’
GPs were capable of auditing referrals within their own practice teams, she added. ‘We can’t let some third-party odd-sod sitting in their closed box-like offices, marking my referral against tick-box performance, deciding whether Mr X deserves to see a specialist or not.’

Representatives also backed a motion calling on GPs to refuse to co-operate with referral systems unless patients consented to have their referral letter accessed by the system, they are evidence-based, educational, voluntary and does not seek to replace proper support to consultants.

Dr Julian Bradley from Buckinghamshire said: ‘Referral, if not GPs only function, is one of our key functions, as gatekeeper, as navigator, and most importantly, as patient champions. We introduce or co-operate with systems that depersonalise and second-guess at our profession’s peril, and peril to our patients confidence in their GP.’

He added that there were issues with patient confidentiality with referral management schemes accessing patient records.

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