HEALTH chiefs have defended a controversial policy of private companies vetting GP referrals for hospital appointments – after a health trust member revealed his hernia consultation had been delayed by ten weeks.

Concerns over the scheme which requires GPs to go through third parties before patients can be referred to specialists include: the undermining of the doctor-patient relationship, decisions taken without full medical histories and the potential for operations to be restricted.

Delays in receiving care, rising workloads and bureaucracy for GPs were also raised at yesterday's County Durham and Darlington NHS Foundation Trust’s annual general meeting.

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Senior trust executives said the measures, now widespread for many conditions including cardiology, gynaecology, dermatology and gastroenterology, has improved the quality of the referrals.

But retired teacher and education officer John Deller, 64, from Shincliffe, who is a trust member, said his appointment for a hernia consultation was delayed by ten weeks due to the ‘value-based clinical commissioning policy’.

As part of the system, once he saw his GP, he then had to be issued with a Prior Approval Ticket before he could see a specialist.

“The GP does not make a decision any more," he said."They have to put forward your symptoms and a board makes a decision. It took ten weeks for my own case.”

Referral management systems, designed to cut unnecessary appointments, are being introduced by Clinical Commissioning Groups across the country.

Last October, North Durham CCG launched its own pilot scheme with About Health, in which the company receives £10 per referral letter

Durham City MP Roberta Blackman-Woods has raised concerns and called for the new system to be halted.

A similar scheme, the Clinical Assessment and Peer Review, (CASPeR) was rolled out in Darlington and parts of Teesside this summer.

After the meeting, at Durham Town Hall, trust chief executive’s Sue Jacques said: “The quality and completeness of the referrals has improved because it is guiding a GP to document what a secondary care clinician needs when they get that referral. It is less likely to be an inappropriate referral.”

North Durham Clinical Commissioning Group said the aim was to make sure practices follow clinical guidelines which have been agreed locally with GPs, hospital consultants and other relevant practitioners.

A spokesman said: “The referral process is not intended to restrict any access to procedures, rather avoid unnecessary hospital appointments, and have all necessary tests done first.”

The trust’s medical director, Jeremy Cundall, said: “

“A specialist might see hundreds of people with a certain problem in a year, but a GP might only see one a year so it is giving them guidance in specialist areas to make sure they send the appropriate patient to the hospital.

“GPs are known as the gatekeepers for a reason. They are there to treat what they can locally and send in what they can’t.

“It is becomes incredibly complicated because the number of patients they see with specific problems is actually quite small. This helps guide them so they send the right people in.”