GP leaders in Kent have raised concerns around a new electronic referral system developed by the ICB, which could lead to liability issues for practices and increased workload.
EROS, a new electronic referral system for GPs being implemented in Kent and Medway, is going to be expanded to more specialties, including gynaecology and urology pathways.
Musculoskeletal (MSK) and ear, nose, and throat (ENT) pathways are already live on EROS with dermatology, gastro and general surgery also ‘soon to be launched’, according to the ICB.
The system has been created using national guidelines, and the ICB said that it has been ‘comprehensively tested’ from the point of referral in general practice through to receipt of referral in acute and community settings.
Once rolled out completely, the ICB hopes that EROS will help ‘reduce GP workload’ and ‘improve outcomes for patients’.
But Kent LMC said that it has raised concerns around ‘potential risks’ at ‘multiple points’ during the implementation, and that it is concerned that GPs could bear responsibility for errors occurring within the new system.
While its use is not currently mandated by the ICB, the LMC is also concerned that GPs may be led to undertake pre-referral investigations which ‘go beyond the scope of a GP’.
In an update, the LMC said: ‘We have raised concern around the ongoing maintenance and clinical governance to ensure that pathways are kept up to date and thus that the user is being led to the correct outcome.
‘We are concerned that GPs may be led to undertake pre-referral investigations which go beyond the scope of a GP; we have been assured by the ICB that this will not be the case.
‘Currently it is unclear where responsibility will lie if errors do occur. There is potential that it could be with the user (clinician), and if the error is a result of the user input due to not being trained, this is a potential risk for the employer of that clinician, if practice processes have not been put in place.
‘At this time we are not assured the hazards identified have been resolved to an acceptable level. We note that work is continuing to resolve identified hazards by the ICB.’
A clinical safety report on EROS will be prepared and shared with practices, and if practices choose to use the system they will need to ensure that staff are ‘adequately’ trained and that practice level ‘standard operating procedures’ are in place, the LMC added.
In response to the concerns, a spokesperson for the ICB told Pulse: ‘We will continue to work with GPs and partners as we develop the Electronic Referral Optimisation System (EROS).
‘When rolled out, EROS will help reduce GP workload, enhance safety and governance and improve outcomes for patients.’
Last year, Pulse revealed that concerns about hospital specialists downgrading GP cancer referrals, a measure which has caused ‘considerable alarm’ due to the risk of missed diagnoses.
In other areas, GP leaders are pushing back against hospital trusts rejecting referrals, with LMCs issuing warnings of potential contract breaches.
A number of LMCs have encouraged GPs to send warnings back to providers who reject their referrals, stating that there are no valid grounds for the rejection.
It comes after Pulse revealed that GPs are concerned about a rise in rejected referrals and particularly from ‘anonymous’ clinicians, with referrals coming back to general practice unsigned, and patients being put at risk when secondary care and other providers do not accept GP referrals.
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