General practitioners will have their referral decisions scrutinised by colleagues in a new system of “clinical peer review” launched this month by NHS England. The move has been criticised by the doctor’s union the British Medical Association as questioning the authority and expertise of health professionals and giving them further obstacles to delivering quality care.
The reform is aimed at cutting costs but has been described by the NHS as a bid to offer “constructive feedback” and explore “all options” to reduce hospital referrals by up to 30%.
No faith in GPs
Critics say the move imposes further bureaucratic burdens that will stop doctors from carrying out their primary duty of care. Andrew Green, UK clinical and prescribing policy lead on the BMA’s General Practitioners committee, found the language of the proposal unrealistic.
“GPs are used to seeing un-referenced claims such as “could reduce by up to” in adverts for anti-wrinkle cream and I am surprised to see such language in an official document,” he said.
“It is important to be aware of the lost-opportunity costs of schemes like this if we assume an hourly weekly meeting that would be equivalent to removing 1000 GPs from the English workforce. GPs we don’t have.”
The irony of the scheme is that it requires further time and investment that the NHS simply cannot afford. Meanwhile it takes power away from the people who know what is best for their patients by questioning their authority and bringing in guidance from colleagues who have not had that personal contact with the patient.
The issue of making GPs act in the best interests of both patients and the wider service’s budget is a long-standing one. Eight years ago the BMA warned of the role of referral management centres that acted as fjilters intended to direct patients to the best form of secondary care.
The health watchdog the King’s Fund said these efficiency measures were instead costly and damaging to patient care. “They can exact a high overhead per referral and if the cost of the alternative service is taken into account their value for money is questionable,” it said.
“They may also undertake clinical decisions in the absence of full clinical information and thus present clinical risks, especially if based on a poor-quality referral. Plus they can be confusing to patients who may not understand what they are and how they relate to their GP and the hospital.”
Any Benefits?
Despite the BMA voicing scepticism about the new plans a study by the National Institute for Health and Clinical Excellence said that having more doctors analysing each patient’s case improved support and diagnosis.
“A 2013 analysis of peer-reviewed referrals found that there had been 206 cases in which peer reviewers felt that a patient’s history or symptom pattern presented a high risk of cancer that was not indicated in the original referral,” it said. “As a result of peer review the referring clinicians upgraded around 50% of those referrals from routine to high risk, reducing the time to appointment for those patients by 2–3 months.”
Nevertheless Nottingham GP Irfan Malik told the BMA that placing further pressure on understaffed surgeries was unnecessary given the care every GP makes in each referral choice. “From my personal view I can’t see any advantages to this,” he said.
“We think very carefully about hospital referrals before we make them and discuss the decision with the patient. I can’t see how having to have meetings or analysing these referrals will create a more effective process.”
by Stewart Vickers
The post NHS: New Red Tape Strangling GPs appeared first on Felix Magazine.
NHS: New Red Tape Strangling GPs posted first on http://www.felixmagazine.com/
No comments:
Post a Comment