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London GPs to restrict specialist referrals under new rationing plans

Outpatient appointments could be replaced with phone conversations

London GPs will be urged against referring patients to hospital specialists and consultants as part of an NHS rationing programme introduced in the capital, reports suggest.

The programme could also see some outpatient appointments being axed.

The changes, some of which will take effect immediately, include significantly reducing referrals to consultants, replacing some outpatient appointments with a phone conversation, and urging GPs to find “alternative ways” of dealing with patients who need hospital referrals, the Guardian reports.

The plans were communicated in a letter from the North West London Collaboration of clinical commissioning groups (NWLCCCG), which funds NHS health services for more than two million Londoners, to key individuals including local MPs just under two weeks ago.

It refers to a financial recovery plan and admits that “some ideas, especially those affecting patients, will generate strong views and we will need to make some difficult choices”.

Dr Gary Marlowe, BMA London regional council chair and London GP, said that while the financial pressures that clinical commissioning groups (CCGs) were under was appreciated, “cost-cutting must not come at the expense of quality patient care or increased bureaucracy and workload for doctors”.

“All clinicians – whether in GP practices or in hospitals – must be able to make decisions over what is best for the patient in front of them, based on their own clinical evidence base, and not be blocked by arbitrary money-saving restrictions,” he added.

He warned that by restricting referrals patients are prevented from receiving the best treatment for their individual condition.

Prof Martin Marshall, the vice-chair of the Royal College of GPs, said it is paramount that any initiatives do not lower the standard of care that patients receive.

A spokeswoman for NWLCCCG said: “Some of the proposals that emerge will see changes to patient services. We will engage patients as plans develop but as with any change there will be people who do not agree with our proposal. Some ideas will affect clinical services and in putting forward our plans we want to emphasise that the safety of our patients and the quality of our services will always come first.”

The spokeswoman added that they would ensure no patient waited more than 52 weeks for treatment.

She said that referrals to consultants in different specialties would continue “within agreed pathways” but that “inappropriate referrals” would be stopped.