Delays and disarray: Hospital referrals in chaos


Secretary of State Hewitt

Acutely ill patients are facing major delays in receiving care because new electronic referral systems prevent consultants prioritising between urgent and routine cases, an investigation by Pulse has revealed.

Patients are also being denied appointments at hospitals they want to go to, being referred on multiple occasions before getting an appointment and forced to wait far longer than necessary, research involving consultants from 64 hospitals finds.

The problems stem from technical issues with the Choose and Book referral system and restrictions on referrals by cash-strapped PCTs and NHS Trusts.

Of the consultants asked by Pulse about the impact of Choose and Book, 40 cited major problems.   These included:

* Referrals have to be sent back to the GPs and started from scratch because attachments sent via the Choose and Book system are either not arriving or can't be opened
* Referral process has to start from scratch if the patient has been referred to the wrong clinic because Choose and Book stops
consultants referring internally to other consultants
* If urgent cases are spotted, the patient has to wait longer at the hospital because clinics are full of non-urgent cases 
* Referral letters often arriving only one day before a patient's appointment, preventing consultants from doing essential pre-appointment investigations
* Referral management centres are intervening in decisions made by GPs and patients about their care and forcing people to travel long distances. This is done to save money and ensure hospitals meet Government waiting time targets

Professor Jonathan Edwards, Professor in Connective Tissue Medicine, University College London: said: 'The whole thing is a complete disaster. We are having every possible problem.'

Professor Andrew Bamji, consultant rheumatologist at Queen Mary's Hospital in Sidcup, Kent and president of the British Society for Rheumatology said: 'It is often impossible to get into the system to look at referrals, so we have no idea what is coming or whether routine referrals should be reclassified as urgent.'

Consultants' complaints follow criticisms by GPs, who are being stopped from referring to a patient's preferred hospital or a named consultant and are finding more referrals being bounced back.

Dr Lucy Marchand, a GP in Bletchley, Milton Keynes, said GPs at her practice were being prevented from referring if hospitals could not offer a slot within the Government's 13 week waiting time target.

She said: 'These referrals automatically get removed from the [Choose and Book] system, which takes away patient choice.'

A spokesman for Connecting for Health said Choose and Book '[did] not in itself create the problems which Pulse's survey has raised'.

He added: As utilisation increases there are inevitably new challenges to implementation, especially in trusts where capacity is stretched.'

Jo Haynes, editor of Pulse, said 'This is all being caused by a fundamental conflict between the Government's patient choice agenda and PCTs' increasing need to cut hospital referrals to save money.

'Technical problems with Choose and Book are then making the situation worse. These three elements are the corners of a Bermuda triangle in the NHS. And patients are disappearing in the middle.'

(30/11/06)