NHS bosses refused to comment on costs as they confirmed there will be no public consultation over a contentious scheme that could block GP referrals.

Politicians and medical professionals have criticised a pilot scheme that forces North-East GPs to submit the majority of their referrals to a third party for approval.

The Clinical Assessment and Peer Review scheme (CASPeR) was rolled out in Darlington and parts of Teesside this week – despite a similar initiative in North Durham finding just ten per cent of assessed referrals were not appropriate.

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The Northern Echo has asked for a detailed breakdown of the costs involved in establishing and operating CASPeR but was told by a spokeswoman for the North of England Commissioning Service that the information was commercially confidential and would not be released.

She said a similar scheme introduced to North Durham involved a cost of £10 per referral triaged, but could not expand on the issue further.

The North Durham scheme was introduced in October 2016 and since its inception has seen 827 referrals - just ten per cent of those submitted for approval – returned to GPs, while another nine per cent were triaged differently.

The North Durham CCG said there had been an overall reduction in referrals of 13 per cent and that they had not been made aware of “any adverse clinical outcomes”.

However, Durham MP Roberta Blackman-Woods - who has campaigned on the issue alongside MP Kevan Jones - called for the system to be scrapped.

Ms Blackman-Woods said "just five or six" CCGs across the UK were enlisting private firms to fulfil referral management contracts, including North Durham and North Tyneside.

She said there was little evidence to prove such initiatives – which aim to reduce pressure on the health service by diverting inappropriate referrals – were working.

The politician criticised the NHS for failing to collect clinical data from the scheme in Durham and for passing patient data to private companies without their knowledge.

Ms Blackman-Woods said: “Only one in ten referrals are being sent back, so why is it necessary to have a huge system in place for such quite low returns?

“We have really grave concerns still and do not want our CCG to use this kind of system, we believe it is causing delays and it would be dreadful for the same kind of system to be introduced in Darlington and Teesside.”

A spokeswoman for the North of England Commissioning Service said there was no evidence from schemes in other areas to suggest CASPeR would cause additional clinical risk or delay treatment.

She said many patients could be effectively treated by a range of NHS services without requiring a referral to hospital, adding: “This scheme aims to ensure that the patient has had all the investigations and appropriate management enabling them to see the right person, first time when referred. This also frees up appointments within secondary care."

We ask NHS for answers on new referral system

THE Northern Echo asked the North of England Commissioning Support group to answer a number of questions about CASPeR.

Here are the answers received so far:

Can you provide a breakdown of the costs involved with the implementation and operation of CASPeR, including how much the NHS paid to HASH to fulfil the contract?

This level of information would be deemed to be commercially confidential so we are unable to share this.

How is the system being funded?

The service is being commissioned out of existing NHS resources which have been assessed and allocated accordingly.

Who will be delivering the system?

The CCG has commissioned the GP federation, Hartlepool and Stockton Health (HASH) to deliver the service on a pilot scheme basis, engaging with Primary Healthcare Darlington as part of the process.

How will it affect access to specialist services?

It may be that a patient could be seen in the community rather than a hospital to get the advice or support the GP has requested.

All referrals are triaged against agreed clinical criteria based on best practice guidance, such as NICE guidance, and have been developed with local GPs.

Will those assessing referrals be specialists or consultants? What is the required level of expertise for assessors?

The provider commissioned to deliver the service has assessed the pathways in place and has appointed relevant clinicians to undertake any clinical triage required.

We expect they will mainly utilise the expertise of local GPs but they have links to consultants should further discussion need to take place.

Outside of this pilot system, secondary care providers also have requirements to offer advice and guidance to GPs and all local practices are being encouraged to utilise this where required.

Will assessors have access to patient notes and medical history?

The provider will have access to the referral information sent to them by the patient’s GP.

They will also be able to call and speak to the referrer should further discussion be needed.

Have GPs in Darlington been consulted on this and given a say in the plans?

The CCG has undertaken a number of events to consult with practices across Darlington on plans including this system. Local GPs have also been involved in developing the guidelines.

Will the public be consulted on this issue?

Formal public consultation normally happens when there is a change to NHS services that is deemed to have a significant impact upon patients. This does not fall into that category.

We have produced patient posters and leaflets, added these to the CCG websites and sent these materials to practices to share.