DAUK’s joint letter to the health secretary – lack of access to secondary care referral pathways

Gp Online and Medscape wrote about our letter to Sajid Javid – you can read the letter here:

Dear The Rt Hon Sajid Javid,

We write to you as a very concerned group of GPs regarding the lack of access to secondary care referral pathways.

You will of course be aware that access to secondary care outpatient services now has extremely long waits across a range of specialities. 

This is putting huge undue pressure on primary care. For example, those waiting for joint replacements do not contact their surgeon for fit notes, pain relief, antidepressants whilst they are waiting. This is one small example of the very real-world consequences for GPs when our patients cannot gain the specialist in put they need. We are additionally seeing patients waiting months for physiotherapy and years for certain mental health assessments for autism and ADHD. These are just a few examples. 

As GPs we are seeing an increasing amount of referrals rejected at the outset. This is a huge concern for us regarding patient safety. It also often leaves nowhere to go with that patient and their care. 

Therefore, those who have the resources are turning to private referrals, those who can’t are left to suffer.

We are also concerned regarding the growth of mandated advice and guidance (A&G) as is being trialled in London currently. A&G is a brilliant tool if there is a query over patient care, or some concern over whether a referral is appropriate. 

However, as GPs, if we have decided a referral is necessary, and the situation is outside our competency then we must refer onwards, in line with GMC advice. 

Allowing specialists who have not assessed the patient themselves to make the decision whether a referral is justified, is not in keeping with the current emphasis on face-to-face consultations, and risks patient safety. 

We are witnessing a huge increase in demand in demand for private referrals. A recent poll of our members showed 100% of the doctors who replied believed private referrals were on the rise. 

Whilst private referrals have their place for some patients, patients should not need to resort to them for necessary care.

Most concerning of all, 90% of respondents believed a patient of theirs had come to harm because of a lack of access to outpatient services. 

Our worry is this lack of access to secondary care, followed by increased rationing of specialist opinions is now leading to two-tier healthcare – where the NHS is available for acute emergencies and cancer care, but to have good, appropriate management of many common conditions, patients must either fund their own care privately or suffer. This is not only against the founding principles of the NHS, it stands to widen health inequalities. 

There must be urgent action to remedy this. 

We ask:

  • recognise the impact of these waits on primary care, the need for greater resources and a review into primary care access
  • recognise that if GPs need to refer patients, rejection of referrals must be the exception. A clear explanation and alternative plan must be given. All rejection letters should be personalised and written directly to the patient, with the GP copied in
  • halt all moves to mandate A&G
  • continue discussions to reduce waiting times
  • finally, please visit our practices. Please come and understand first-hand the pressures we are under and listen to the solutions. Some things need decades to remedy, but there are quick wins too.

We look forward to hearing from you.

DAUK GP committee

Doctors for the NHS

GP Survival

999 Call for the NHS