Nav: Home

The BMJ reveals private firms run one-third of CCGs' schemes to screen GP referrals

January 04, 2017

Clinical commissioning groups (CCGs) in England are spending millions of pounds on schemes that screen patient referrals from GPs to specialist services, reveals an investigation by The BMJ today.

Overall, two in five of the CCGs that responded to The BMJ's requests for information use a referral management system of some kind, and a third of the schemes are provided by private companies.

Some of the schemes aim to reduce costs, while others hope to improve the quality of referrals. But almost three quarters of CCGs which responded were unable to provide evidence that showed whether or not their scheme had saved money overall.

The analysis follows The BMJ's recent report on North Durham CCG's decision to commission the private company About Health to screen GP referrals to reduce "unnecessary" outpatient activity and save money.

The move sparked concerns from clinicians and The BMA, which warned that CCGs risked repeating mistakes of predecessor organisations by commissioning schemes of questionable effectiveness.

The BMJ sent freedom of information requests to all 211 CCGs in England. Of 184 CCGs that responded, 72 (39%) said they currently commissioned some form of referral management scheme to help manage outpatient activity in local hospitals.

The findings show:

- 93 referral management schemes in operation across 72 CCGs, with some CCGs operating more than one scheme

- 32% of schemes are run by private companies, 29% in house, 11% by local NHS trusts, 11% by NHS commissioning support units,10% by the voluntary sector, and 7% by local clinicians

- 69% of CCGs with schemes disclosed operating costs. These CCGs combined have spent at least £57m on schemes since April 2013

- Only 14% of CCGs provided figures to show that the scheme had saved more money than it had cost to operate, and 12% showed that their schemes had not saved money overall

- 74% of CCGs with schemes failed to supply figures to show whether money had been saved overall

20% of CCGs commissioned a new scheme since April 2013, and the same proportion are continuing to commission schemes previously set up by primary care trusts

Richard Vautrey, deputy chair of the BMA's GP committee, said "[CCGs] are leaping at these schemes without any clear evidence of benefit and that they're just hopeful that it might reduce their costs. It is a very, very short term approach to healthcare management. We need to see much more evaluation...and not just keep making the same mistakes year after year."

The lack of evidence provided to The BMJ on savings was a particularly concerning finding, he said: "As public bodies, there should be an expectation on every CCG to account for what it's doing."

But some of the schemes that enabled local specialists to provide rapid advice and guidance to GPs "can be very helpful", explained Vautrey.

Graham Jackson, co chair of NHS Clinical Commissioners, the membership organisation which represents CCGs, said referral management was just one mechanism that local groups use to try to manage demand for services.

"In many cases they provide a useful and effective role which is more than a redirection service," he said. "CCGs will balance the cost of commissioning with the benefit they provide to GPs and patients in terms of peer review, education, caseload management and choice."
-end-
Investigation: Referral management schemes: good for whom?
http://www.bmj.com/cgi/doi/10.1136/bmj.i6856

News story: Private firms run a third of CCGs' schemes to screen GP referrals
http://www.bmj.com/cgi/doi/10.1136/bmj.i6855

About BMJ

BMJ is a healthcare knowledge provider that aims to advance healthcare worldwide by sharing knowledge and expertise to improve experiences, outcomes and value. For a full list of BMJ products and services, please visit bmj.com

BMJ

Related Gps Articles:

Two in 5 GPs to 'quit within 5 years'
Around two in every five GPs in the South West of England have said they intend to quit within the next five years, exposing the magnitude of the region's impending healthcare crisis suggesting that the picture for the UK may be particularly challenging.
First-ever GPS data release to boost space-weather science
Today, more than 16 years of space-weather data is publicly available for the first time in history.
GPs not dissatisfied with performance related pay, study finds
Linking GPs' pay to their performance has no discernible effect on their job satisfaction, a University of Manchester study of almost 2,000 UK doctors over a four-year period has found.
No GPS, no problem: Next-generation navigation
Researchers at the University of California, Riverside have developed a highly reliable and accurate navigation system that exploits existing environmental signals such as cellular and Wi-Fi, rather than the Global Positioning System (GPS).
Rapid blood test by GPs can rule out serious infections in children
Using a simple decision rule and a finger prick to test blood, GPs could substantially reduce the number of ill children being referred to hospital, if the test is used on children identified as 'at-risk' of a serious infection.
GPs' uncertainty at dealing with those bereaved by suicide revealed
Interviews carried out by the University of Manchester with GPs of parents whose children have died by suicide have revealed a lack of knowledge and confidence on how best to respond to and support those bereaved.
Study uses GPS technology to predict football injuries
Footballers' injuries may be predicted by looking at players' workloads during training and competition, according to new research.
GPS jamming: Keeping ships on the 'strait' and narrow
The University of Nottingham and Royal Norwegian Naval Academy (RNoNA) are investigating how to prevent shipping Global Positioning Signals (GPS) being jammed in potential cyberattacks that may cause vessels to go off course and collide or run aground.
Research will help GPs diagnose urinary tract infections in children
Urinary tract infections in young children can lead to kidney damage, but are notoriously difficult to diagnose in primary care because symptoms can often be vague and unclear.
Like humans, lowly cockroach uses a GPS to get around, scientists find
Rats, men and cockroaches appear to have a similar GPS in their heads that allows them to navigate new surroundings, researchers at Case Western Reserve University report.

Related Gps Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Anthropomorphic
Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#SB2 2019 Science Birthday Minisode: Mary Golda Ross
Our second annual Science Birthday is here, and this year we celebrate the wonderful Mary Golda Ross, born 9 August 1908. She died in 2008 at age 99, but left a lasting mark on the science of rocketry and space exploration as an early woman in engineering, and one of the first Native Americans in engineering. Join Rachelle and Bethany for this very special birthday minisode celebrating Mary and her achievements. Thanks to our Patreons who make this show possible! Read more about Mary G. Ross: Interview with Mary Ross on Lash Publications International, by Laurel Sheppard Meet Mary Golda...