Do you live in Darlington, Stockton or Hartlepool? Your hospital referral could be blocked as GPs told to submit requests for approval

Doctors and politicians have branded the pilot scheme being rolled out across Darlington and parts of Teesside this week as "extraordinary" and "healthcare rationing by the back door" and believe it could delay treatment and compromise patient safety.

The majority of referrals from GPs in Darlington, Stockton and Hartlepool will be submitted for a decision by an assessor before either being sent back to GPs with alternative suggestions or passed on to hospitals or specialists.

It is understood the assessor may not have access to patients' medical notes.

The Clinical Assessment and Peer Review (CASPeR) system, which is hoped will reduce pressure on hospitals and cut costs, will focus on referrals in ophthalmology, gynaecology, cardiology, rheumatology, ears, nose and throat, dermatology, gastroenterology and urology.

Cancer referrals among a group of medical areas unaffected by the change.

In recent years, clinical commissioning groups (CCGs) - which are run by GPs - across the country have spent millions on initiatives designed to improve the quality of GP referrals in order to cut down on unnecessary outpatient appointments.

The CASPeR system has been commissioned jointly by CCGs in Darlington, Hartlepool and Stockton.

A description of the system on Darlington CCG’s website says it is “an additional specialist clinical opinion available to support GPs to make decisions about what the most appropriate treatment plan should be for a patient”.

Darlington GP and specialist cardiologist Professor Ahmet Fuat is among a number of medical professionals to voice concerns about the initiative.

The GP of more than 30 years said those assessing his referrals could have less experience than he does and will make a decision based solely on the referral letter itself.

He is now calling for decision-makers on the scheme to be consultants or specialists with expertise relevant to the referrals they are considering.

Professor Fuat said: “We are all being pressured to reduce spending in the NHS and that’s the reason behind this – for every referral we make, there is a charge.

“I do not necessarily have an issue with referral management as long as it is done properly and introduced following consultation with GPs.

“Those deciding will not have access to patient notes, they will get a letter, check it against guidelines and either send it on as requested or send it back - that will cause a delay in the referral and a delay for the patient.

“If they had access to notes, this would be a lot easier and safer as they could go in and see exactly why we referred in the first place.”

He added: “It concerns me that this is being rushed through and that the GPs in Darlington had no idea about it at all until we were told it was going to happen around two months ago.

“This is just one of many things that are happening where healthcare is being rationed by the back door as an effect of an agenda of false austerity that is being imposed upon us.”

Darlington MP Jenny Chapman said: “It seems extraordinary that experienced professionals are being told to use this system when their role is to use their own clinical judgement.

“I am not aware that there has been any huge issue with GPs making inappropriate referrals.

“If there is evidence of that, the right thing to do is to have a dialogue with GPs rather than impose something like this.”

Darlington CCG’s website says the system will “ensure patients are treated in the most appropriate way, first time”, adding: “Unnecessary outpatient appointments are a large cost to the NHS.

“CASPeR is being put in place to make sure practices follow clinical guidelines agreed locally with GPs, hospital consultants and other relevant practitioners.”

A similar system was introduced across North Durham last year, with MP Roberta Blackman-Woods then calling for it to be scrapped, and stating she believed it could compromise patient safety.

Earlier this year, Professor Helen Stokes-Lampard, chair of the Royal College of GPs, stated it was concerning to see little evidence of referral management centres saving money and called for better evaluation of such schemes.