Urgent referrals rejected for one in three GPs during COVID-19 outbreak

More than three quarters of GPs fear delays to care because of COVID-19 will harm patients, with one in three reporting that urgent referrals have been rejected during the pandemic, a GPonline poll shows.

GPs have had urgent referrals for suspected cancer rejected (Photo: ER Productions Limited/Getty Images)
GPs have had urgent referrals for suspected cancer rejected (Photo: ER Productions Limited/Getty Images)

The poll of 415 GPs found that 77% were concerned that delays to operations and treatments for non-COVID-19 issues would result in patients coming to harm.

Meanwhile, 30% of GPs said they have had an urgent referral rejected during the pandemic. Rejected referrals included two-week-wait referrals for suspected cancer as well as urgent referrals for investigations such as ECGs, echocardiograms and CT scans.

GPs also highlighted concerns over delays to treatment for cancer, with respondents warning that breast cancer surgeries had been postponed or chemotherapy delayed.

COVID-19 impact

Meanwhile, several GPs expressed concern about delays in patient access to mental health services and specialist dementia care during the pandemic.

GPs were told by NHS England in mid-April to refer patients to hospitals for all treatments 'as normal', but many have since reported that their referrals are still being rejected.

NHS trusts were given the green light to suspend non-urgent hospital treatments in March, although in further advice they were told to 'give appropriate clinical priority' to cancer diagnosis and not to 'downgrade urgent cancer referrals without the consent of the referring primary care professional'.

GPonline's findings come as doctors are increasingly warning of the impact the pandemic will have on those with conditions other than COVID-19. Last week GPonline revealed that some patients had yet to be offered appointments more than a month after being referred on the two-week urgent cancer pathway around the time that the UK went into lockdown.

Long-term health fears

Meanwhile, half of GPs (53%) responding to GPonline's survey were also concerned that patients were not contacting their practice for medical help when they should be because of the COVID-19 outbreak. This backs findings from a recent NHS England poll, which suggested that millions of patients are avoiding seeking help from their GP during the pandemic.

Referrals on the two-week pathway have dropped sharply since the coronavirus outbreak, which NHS England has attributed to the fact that people are not seeing their GP. Health charities have also warned that suspension of some routine GP services during the pandemic could lead to a 'future crisis' if control of conditions such as asthma and COPD deteriorates.

There has also been a drop in A&E attendances and patients attending hospital for heart attacks. A poll of 16,000 doctors by the BMA this week found that half believe the coronavirus outbreak has worsened care for patients.

One GP responding to GPonline's poll said: 'I am concerned there will be a huge build up of work not done due to COVID-19 and that will bring huge pressure on workforce and risk to patients in the long run.'

NHS coronavirus plan

Last week NHS England chief executive Sir Simon Stevens wrote to all NHS providers setting out the second phase of the NHS response to COVID-19, which will see hospitals restore GP access to diagnostic tests and begin to restart urgent and routine care.

Hospitals have been told that 'referrals, diagnostics (including direct access diagnostics available to GPs) and treatment must be brought back to pre-pandemic levels at the earliest opportunity to minimise potential harm, and to reduce the scale of the postpandemic surge in demand'.

Health and social care secretary Matt Hancock said that the resumption of services would start 'with the most urgent like cancer care and mental health support'.

Speaking at a Downing Street briefing last week he added: 'The exact pace of the restoration will be determined by local circumstances on the ground, according to local need and according to the amount of coronavirus cases that hospital is having to deal with.

'The principles are that the most urgent treatment should be brought back first and also that it needs to be according to the local demands on the system. There are parts of the country where the number of COVID patients is much lower than in other parts and so it has to be locally driven.'

Vital care deferred

NHS England has also launched advertising campaigns to stress that the NHS is 'open' and to encourage patients to seek help if they need it.

BMA GP committee chair Dr Richard Vautrey said: 'There’s a real concern that patients are either not engaging with health services the way that they normally would and that vital care is being deferred, risking conditions getting worse and requiring more acute care in future. This obviously has a serious impact on patients, but will also likely result in a wave of increased demand once the current COVID situation eases.

'The BMA is urging the government and NHS England to set out a credible and realistic plan of how it intends to continue to meet the current demand of COVID-19, while resuming services for patients who so desperately need care for unrelated, but often painful and distressing, conditions – including re-establishing referrals pathways and access to diagnostic services.'

Professor Peter Johnson, NHS national clinical director for cancer, said: 'NHS staff have made huge efforts to deal with coronavirus but they are also working hard to ensure that patients can safely access essential services such as cancer checks and urgent surgery.

'From online consultations to the roll-out of cancer treatment hubs we are doing all we can to make sure patients receive the life-saving care that they need. The wishes of patients and their families will always come first, and we have to make sure that people feel safe coming to hospitals, but my message is clear: people should seek help as they always would.'

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