Barriers to inpatient treatment create ‘two-tier’ NHS, GPs warn


In an open letter to Health and Social Affairs Secretary Sajid Javid, GPs from Doctors Association UK (DAUK) expressed concerns that “access to outpatient secondary care services now requires extremely long waits in a range of specialties ”.

The letter warns that long waits for hospital treatment and an “increasing number of initially rejected referrals” are “putting enormous undue pressure on primary care.”

The letter comes just a day later GPonline reported a report from the National Audit Office which highlighted the huge increase in long waits for NHS hospital treatments during the pandemic – but also warned that increasing wait times had put pressure on general medicine long before the pandemic.

General references

DAUK’s letter to Mr Javid cautions: “Those awaiting joint replacement do not contact their surgeon for adjustment notes, pain relief, antidepressants while they wait. This is just a small example of the very real consequences for GPs when our patients cannot get the specialist advice they need.

“Additionally, we see patients waiting months for physiotherapy and years for some mental health assessments for autism and ADHD. These are just a few examples. ‘

The letter warns that a growing number of referrals rejected by hospitals often leave general practice with “nowhere to go with this patient and his care.”

As a result, he adds: “Those who have the resources turn to private referrals, those who cannot are left to suffer.”

General practitioner workload

DAUK GP leader Dr Lizzie Toberty also raised concerns over the use of ‘advice and referral’ mechanisms in the NHS, warning that the system has become a barrier to further referral by general practitioners.

She said: “If a GP has decided that a referral is needed and the situation is beyond their purview, then they should make a referral, as advised by GMC. Allowing specialists who have not assessed the patient themselves to decide whether a referral is warranted, is inconsistent with the current emphasis on face-to-face consultations and endangers patient safety. ‘

DAUK warned the NHS was becoming “a two-tier system with a lack of referrals and long waiting lists forcing inequality of medical care across the population.” Along with other groups representing NHS staff – Doctors for the NHS, GP Survival and 999 Call for the NHS – he called on Mr Javid to ‘recognize the impact of these expectations on primary care, the need for more resources and a review of primary care access to care ”.

The groups also ask that dismissal of referrals be only in exceptional cases – and with “a clear explanation and an alternative plan”. Campaigners said rejection letters “should be personalized and written directly to the patient, with a copy from the GP.”

Doctors for NHS spokesman Alan Taman said: “The growing trend of private referrals demonstrates the critical need to invest in the NHS and address staffing issues that have been developing for years and will take years to be resolved.

“People shouldn’t have to pay for their own treatment because otherwise they will have to wait months or even years or be unable to receive treatment from the NHS because it has been cut. As a rule, privatization does not take place on a broad contractual basis, through competition from private companies for service contracts, at least not yet. It happens one worried person at a time, those who can afford to pay or increasingly who can get into debt.


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