GP Specialist Referral Service – Roberta Blackman-woods, M.P. has asked to address the Committee in respect of the GP Specialist referral service implemented within North Durham CCG.
Minutes:
Roberta Blackman-Woods, MP had asked to address the Committee in respect of the GP Specialist referral service implemented within North Durham CCG and indicated that the scheme was a referral system to a specialist via a private company which were based in the North West of the country. The company would agree the referral or offer another form of treatment. She had been advised of the new system 4 days before the commencement of the new contract. Her office had submitted Freedom of Information requests into every CCG in the Country. They had received a 92% response rate from CCGs using an SRO system and less than 5% were operating a similar scheme and 25% had an in house NHS scheme.
She stated that she had been contacted anonymously by local GPs stating their concerns that the scheme was compulsory. She then went on to talk about her own experience with the new referral service and stated that she was going to be reported to the CCG because she refused to give permission for her information to be shared. She attended a meeting in August but no representative from the CCG was in attendance. She advised members that she wanted the CCG to come up with a revised scheme where her data was shared within the NHS and not involve a private company. The South of Durham were not adopting the scheme.
The Chairman indicated that a local member had brought a briefing letter to the attention of the Committee which had been discussed.
Dr Neil O’Brien, Chief Clinical Officer for North Durham CCG responded that the Rapid Specialist Opinion (RSP) was a process whereby GPs were encouraged to seek an SRO where alternative treatments might be more appropriate rather than an immediate referral to a consultant. Dr O’Brien stated that the scheme was not mandated. The CCG did monitor the number of practices that had taken up the new scheme and engaged with those who hadn’t to find out if they had any concerns. The web based guidelines were developed over two and half years ago which is best national practice but in addition GPs sat in a room with local Durham consultants to go through a step by step guide. Dr O’Brien gave an example of acne treatment where the RSO might suggest that the patients GP try antibiotics before referral to a specialist. The system is coordinated by a private company but NHS consultants look at the data and they looked at primary treatments before a referral. The system does allow diversion of a referral to advanced primary care, it is a voluntary scheme but excludes all urgent referrals.
Dr O’Brien indicated that the CCG did not undertake a formal consultation but they had informed the Adults Wellbeing and Health Overview and Scrutiny by way of a briefing paper. The CCG had engaged with practices and talked to GPs, although Dr O’Brien conceded that the scheme was implemented quickly but they had not had any adverse incidents. They had undertaken a serious of clinical audits to evaluate the SRO process which would be available at the end of November and they were happy to brief scrutiny on the outcome of the audit.
He also advised Members that there had been a 200% increase in accessing guidelines and there had been no adverse reports made back to the CCG from GPs regarding the RSO system. Dr O’Brien then explained the circumstances which had prevented either himself or the Chair of North Durham CCG from attending the meeting called by the MP.
Councillor Crathorne referred to the general public not being consulted as practise groups do not talk to members the public.
The Chief Clinical Officer for North Durham CCG indicated that they had taken advice and as it was not a service change they did not need to do a formal consultation. GPs could opt out of the system and some GPs had. If a patient was referred for secondary care and if acceptable to the patient they would be contacted and offered a range of acceptable appointments with different locations and waiting times.
Mrs Hassoon asked if the data was shared.
The Chief Clinical Officer for North Durham CCG responded that the information was safe and was only shared when an appointment had been booked.
Mrs Hassoon referred to some patients who would not understand the process and would just give consent without realising the consequences. In reply, Dr O’Brien stressed that if a GP feels that their patient is not fully aware of what is proposed under an SRO, then this should automatically flag that patient as being unsuitable for SRO. He again emphasised that the SRO process is not mandated.
Roberta Blackman-Woods, MP indicated that she had talked to every GP practice in her constituency and they had told her that they had to introduce the new SRO scheme. She remained concerned that the SRO system being used involved the sharing of data to a third party private company and that there were alternative processes available to the CCG for this service.
The Chief Clinical Officer for North Durham CCG responded that GPs all specialised in an area and he could call on a colleague in his practice but some surgeries were small and didn’t have this facility.
Councillor Temple suggested that the Committee take up the offer of a review report from the CCG and that the introduction of the new SRO system had been badly handled by the CCG.
Councillor Bell indicated that the system sounded like it was compulsory and second check with GP referrals was a good idea but he didn’t know why a private company was being used.
The MP indicated that she wanted no change to be introduced without consultation. A more open relationship was needed but at the meeting that she had called for, no CCG representative was present and all she had met was defensiveness.
The Director of Primary Care and Engagement for DDES CCG indicated that the membership of CCG was made up of GP practices and that CCG decisions were based upon the views of their practice members. He suggested that they ask GPs what they wanted to do and if they wanted specialist advice before a referral to a consultant.
The MP asked that a member from scrutiny be involved in a round table event to be held in November.
The Chairman responded that he would be in attendance at the round table event.
Resolved:
That the Adults, Wellbeing and Health Overview and Scrutiny Committee receive a report from the CCG on the audit of the Specialist referral service.