NHS centres 'rationing consultant visits'

New centres that "screen" patient referrals from GPs to hospital consultants are being used by the NHS to ration health care by stealth, say medical professionals. More than a third of primary care trusts (PCTs) have established "referral management centres" that, critics say, are preventing patients from seeing the doctor of their choice and in some cases are prolonging waiting times in order to save cash. In one case, GPs found thousands of referral letters stashed in a cupboard for weeks.

Patients' groups and doctors' leaders say the referral schemes, which are sanctioned by the Department of Health, are creating another tier of NHS bureaucracy and could actually harm people's health. GPs say some centres are refusing to let patients see consultants sooner than the Government's outpatient target of 13 weeks. This limits the number of appointments in any one year - saving the PCT money. In some trusts, people are being sent back to their GPs by doctors employed by referral centres, who decide they are not sick enough to warrant a hospital consultation. In a survey carried out by the medical magazine Pulse, 10 per cent of all PCTs admitted they had a specific target to cut GP referrals.

When patients in Milton Keynes started complaining of long delays, their GPs investigated. Milton Keynes PCT had set up a referral management centre, which was meant to scrutinise all referrals in order to speed access and ensure patients got the right treatment. But Dr Peter Berkin and colleagues discovered a backlog of more than 2,000 letters locked in a cupboard by the centre's secretaries until just short of the 13-week waiting-time target. "It got really scary," said Dr Berkin. "There were cases that could have been very serious and needed to see a consultant quickly. We were horrified. The decisions were taken by secretarial staff, not doctors." A spokesman for Milton Keynes PCT admitted there was a backlog, but said it had mostly been dealt with.

Katherine Murphy, of the Patients' Association, said: "These centres are springing up all over the place, but who's monitoring what they're up to? It seems to be another way of rationing patient care by stealth." Dr Hamish Meldrum, chairman of the British Medical Association's GPs' committee, said: "There is considerable concern among doctors. Where clinicians have been involved, things may be working well, but in other places there has been no effective consultation and it seems the main intention is to cut costs. This is potentially harmful to patients' health."

A Department of Health official said referral centres were a "local initiative" by PCTs, but national guidance had been issued on running them. "They must only be set up where they will have clinical benefits and should add value to patient services. They should not conflict with giving patients more choice [and] must not lengthen the patient journey or create 'hidden' waiting times."

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Australia: Public hospital cancer patients shafted

Secret waiting list figures have exposed the deadly delays Queensland cancer sufferers are forced to endure. Damning internal Queensland Health statistics have revealed cancer patients are waiting more than four times longer than recommended for life-saving treatment. According to the latest figures, priority-two patients, who have been diagnosed with aggressive cancers and internal bleeding, are now waiting up to 48 days for radiation treatment. Queensland Health's recommended maximum waiting time is 14 days to avoid "a significant adverse effect on outcomes". Patients with priority-three conditions, who predominantly suffer breast and prostate cancers, are waiting up to 89 days for treatment. The recommended maximum waiting time is 28 days.

The figures have changed little in the month since Health Minister Stephen Robertson downplayed radiation waiting times as a week-to-week prospect when they were initially obtained by The Courier-Mail. Mr Robertson, who yesterday could not be contacted, has repeatedly insisted the Government is tackling waiting times with a $9.7 billion injection into Queensland's health system. However, a spokesman for the Medical Radiation Professionals Group, a collective of Queensland Health workers, said waiting times would worsen.

Only the Royal Brisbane and Women's Hospital manages to treat patients within recommended waiting times. High-level hospital sources believe the RBWH's short waiting times were being caused by a chronic shortage of specialists able to recommend radiation. The Princess Alexandra Hospital in Brisbane has the longest wait times for category-two patients at 48 days. Townsville hospital has maintained the longest wait for priority-three patients at 89 days.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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