Commissioning

Minister defends Durham plan for private scrutiny of GP referrals

David Mowat, the community health and care minister, has defended a controversial decision by North Durham CCG to require a private company to assess GPs’ referrals of their patients to specialists, following fierce criticism from local MPs.

The CCG announced last month that it was awarding the contract to assess cardiology, gynaecology, dermatology and gastroenterology contracts to About Health, leading to warnings from the BMA that it could “compromise patient safety”.

In a Westminster Hall debate this week, Dr Roberta Blackman-Woods, MP for the City of Durham, said she was “shocked and surprised” by the news.

She described the story of a patient whose referral for a skin condition which turned out to be skin cancer was overruled by About Health, meaning that the cancer went undiagnosed for months, and said GPs had also reported to her that they were being pressured to refer patients to physiotherapy services instead of hospital specialists unnecessarily.

Dr Blackman-Woods added that she was not sure that the scheme was cost-effective, because it could lead to patients being referred to hospital services at a later date with more severe problems.

MPs also criticised the CCG for a lack of transparency in implementing the plan. Dr Blackman-Woods said it had not been mentioned in meetings with her and Kevan Jones, the MP for North Durham, or with the patient reference group.

Jones noted: “The decision changes the fundamental relationship of trust between a patient and their GP. My constituents have never been asked for permission for our private medical information to be passed to a private company.”

Julie Cooper, MP for Burnley, called the decision “a challenge to the professionalism of general practitioners”, saying it was “no wonder” that NHS staff levels are declining.

However, the community health can care minister explained that the changes had been introduced as part of a “locally driven system”, that will ensure clinical out-turns are right.

He added that referral management systems, similar to the About Health contract, had been in use since 2007, and were currently in place in areas including Bromley, Cambridge and Tower Hamlets.

Mowat described About Health as staffed by NHS consultants and GPs and regulated by the CQC “in exactly the same way as a GP practice”.

“It is a one-year pilot that builds on the one-year scheme in North Tyneside. I think it started last month; it covers six disciplines and it does not cover urgent referrals, in particular cancer. All the national requirements for referral-to-treatment times still count in exactly the same way. The local CCG performed a risk analysis before it decided to take the scheme forward and build on what happened in North Tyneside, and the scheme is monitored,” he said.

“I have been told that a very important feature is that there is a clear GP appeals process. If they are not happy with a decision that has been taken, that process can happen very quickly.”

Stephen Dalton, the interim chief executive of NHS Confederation, wrote earlier this week that private companies should not be seen as “bogeymen” in the NHS.

(Image c. Anthony Devlin)

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