So much, by the way, for confidentiality.

To be fair to these minions they are working at the behest of the worst, not possibly the worst, but the worst Secretary of State for Health in many a long year - and that includes Alan Milburn MP - Mrs Hewitt.

Small wonder the NHS is descending into even greater chaos as the days roll by].

Pressure on GPs to cut their hospital referrals is intensifying as the NHS gets ever more desperate to rein in mounting deficits, a Pulse survey reveals.  Almost seven GPs in 10 are being subjected to policies aimed at cutting their referrals, with some facing attempts to cut them by more than 20 per cent.

Referral management centres are the most popular method being used by PCOs. Some 53 per cent of GPs said their referrals were now going via these centres.

Stopping named consultant referrals (45 per cent) and using standardised referral forms (35 per cent) were the next most used restrictions.

`There is no evidence to show new methods such as the referral management system work,' said Dr Thomas Nichols, a GP in Oxford.

`Letters get lost, or we have to make several referrals. There is no way to know the impact on health, but there is a big nuisance factor for GPs and patients.'

Dr Mohammad Mustafa, a GP in Fareham, Hampshire, said: `I have been trained to know what a patient needs and I am upset that my decisions are being challenged because of money issues:

One GP in four had been set a specific target to cut their referrals by their PCO.

Dr Douglas Moederle-Lumb, a GP in Scarborough, said cuts of 20 to 30 per cent were being demanded by North Yorkshire and York PCT.  He said: `Our practice has looked at this carefully and our referrals have not been inappropriate. I am happy to co-operate with the PCO but there must be satisfactory alternatives available. It has created huge bad feeling among GPs.'

Orthopaedics, where 44 per cent of GPs were having difficulties, and mental health (27 per cent) were the specialties where GPs experienced most problems.

More than a third of the first 185 respondents said it was increasingly difficult to refer to a hospital of their choice.

Dr Richard Vautrey, GPC negotiator and secretary of the LMC in Leeds, where PCPs have pushed more follow-ups into primary care, said trusts needed to consult GPs on referrals policies.

He said: `If PGTs work with i their GPs from the start, and identify where patient care will not suffer, and may even be enhanced by new referral procedures, then they will have more success in changing practice.' pulse@cmpmedica.com

More than 60 per cent of GPs are having hospital referrals regularly bounced back to them, Pulse's survey shows.

A bewildering array of reasons are being cited for the returns, which have left GPs exasperated and worried for patients' wellbeing.

One GP in three said they had had a referral bounced back because it had not been submitted in accordance with procedure. Almost 30 per cent cited cases where their referral had been deemed unnecessary and they had been asked to manage the patient themselves.

Dr Lesley Taor, a GP in Orpington, Kent, was one of the 26 per cent to get a referral to a named consultant returned.

`It is ludicrous,' she said. `We can't refer to named consultants, but when referrals reach the wrong person they get bounced back to us, even when the relevant consultant I wanted is in the same building.

`We have had patients with hand problems getting sent to the back chap. One letter I sent to the respiratory department ended up with rheumatology. I get incensed because it is just rationing by another name.'

One GP in five had been told to re-refer because the procedure was cheaper elsewhere.

Dr Claudia Webster-Smith, a GP in Purley, Surrey, said her practice was getting into `referral wars' with hospitals.

She said: `Sometimes we have to refer the patient straight back because we just don't have the capacity in our practice.

`But what if something happens to the patient during this referral war? It's not fair on the patient.

(20/12/06)