I met with senior representatives from North Durham CCG in late August of last year, and discussed a number of issues with them.
However at my meeting with the CCG they omitted to mention that they were about to implement a new scheme which would radically change the way GPs in North Durham could refer their patients to specialists. I was therefore extremely perplexed and surprised to find out from BBC Look North about the referral scheme which had been implemented in October.
The new scheme means that rather than make direct referrals to a hospital specialist, GPs would now have to use a screening process operated by a private company called “About Health” which would decide whether the referral should go ahead or not. I assumed that such a radical change would have been discussed not only with me and Kevan Jones MP when we met with North Durham CCG but also with the wider public who will be affected by the changes.
The piece by BBC Look North prompted a number of responses from constituents who were very worried by the new referral scheme. I did attempt to raise these concerns with the North Durham CCG but unfortunately meetings were cancelled and rearranged without any further information or rationale for such a change in process being outlined by them. I and my fellow MPs now hope to meet the CCG on 3rd Feb 2017.
In order to ascertain whether the government had any role In establishing the new referral scheme I asked for, and was granted a debate in Parliament. The debate also meant that detailed questions could be asked of the Minister about the way in which North Durham CCG set up the new scheme, the reasons for it, and the lack of consultation with key stakeholders before such a new system was put in place. Bodies such as the North Durham Patients Reference Group are there for the very purpose of providing consultation and feedback to the CCG on patients’ experiences, but they were completely in the dark about the implementation of the scheme until just a week before it was introduced, where they were presented with the plans as a fait accompli.
During the debate I also made the point that having a private company deciding whether referrals should go ahead or not fundamentally altered the GP/patient relationship as we have come to understand it in the UK. Furthermore I raised the fact that protocols did not seem to be in place to get a patient’s consent before information about their medical condition was passed to a private company.
I have to say I was not impressed by the Government’s response to the points I made in this debate, especially as David Mowat, the Parliamentary Under-Secretary of State for Health, did not respond to any of the points raised preferring to indulge instead in a party political rant which had no place in a debate of this kind.
If the CCG are determined to have a referral scheme in place, at the very least it should be public, open and transparent, and should have been introduced after extensive public consultation and information, rather than having been introduced under the radar. Even so, I am still not convinced that a referral scheme is necessary in the first place and as yet of course no information on the medium to longer term impacts of this referral scheme on health outcomes for patients has been made available. A 12-month trial of this scheme carried out by North Tyneside CCG showed that there was financial savings for the CCG, but we do not have any details about whether it was also advantageous for the health of the patients involved.
Since the debate in November, I have made an FOI request of every CCG in England to find out whether they are implementing a similar referral process to the one put in place by North Durham CCG, and if so, when they introduced it and what consultation was carried out before the scheme was implemented. I also asked those CCGs which are not currently using a referral scheme if they have any plans to introduce one in the future. I have now received responses from the vast majority of CCGs, and my results show that:
- 5 CCGs are considering implementing a system (2.7%)
- 12 CCGs currently use a private company to manage referrals (6.5%)
- 49 CCGs currently have a system to manage referrals, but this is an ‘in house’ service provided by the NHS (26.5%)
- 119 CCGs have no clinical triage of referrals and no plans to introduce them (64.3%)
The vast majority of CCGs do not use a system to clinically triage referrals from GPs to specialists. Some use a system of peer support or internal referral, and a very small number of CCGs use a private company to review referrals. Based on my findings, I am intending to ask for a new debate in Parliament on this issue, and I will be discussing this issue further with North Durham CCG when I meet them in February.