GPs may face stricter requirements for hospital referrals, with NHS England asking ICBs to develop ‘standardised’ criteria by July this year.
Last week the Government laid out plans to reform elective care and bring down the waiting list, including a commitment to pay GPs £20 per advice and guidance (A&G) request in order to prevent ‘unnecessary referrals’.
Alongside this expansion of A&G, NHS England’s full ‘elective reform’ document also revealed plans to ‘standardise pathway referral criteria’ for GPs, including for ‘pre-referral investigations’.
The plan said NHS England will instruct ICBs and providers to develop these criteria and make them ‘visible to referrers’ by July 2025.
Both NHS England and the BMA said that full details of what these criteria may include are being discussed as part of the Government’s consultation on the GP contract for 2025/26, along with the finer detail of the newly-announced A&G payment.
NHSE also told Pulse that the standardisation of referral pathways will ensure patients have ‘equal access’ to onward care.
The BMA and several LMCs have previously pushed back on trusts rejecting GP referrals, and particularly attempts to enforce ‘proforma’ GPs must complete in order for referrals to be accepted.
Guidance produced by the union told GPs that ‘the use of referral forms is not a contractual requirement’, nor is it a ‘professional obligation’.
NHS England’s referral plans
Integrated care boards will:
- consistently optimise referrals using Advice and Guidance and effective triage, increasing the proportion of patients being treated in the most appropriate care setting – March 2026;
- standardise pathway referral criteria, maximise Advice and Guidance opportunities, and put in place clinical triage standard operating procedures for high-volume specialties.
NHS England will ask systems to work with their providers to develop clear and accessible:
- pathway referral criteria, including for pre-referral investigations carried out in diagnostic setting and which are visible to referrers, by July 2025;
- commissioning arrangements for A&G services, including resource allocation through job planning, by September 2025;
- triage standard operating procedures for high-volume specialties, outlining referral criteria, investigation requirements and sub-specialty booking criteria, by December 2026.
Source: NHS England
Lancashire and Cumbria LMCs CEO Dr Adam Janjua said it is ‘all well and good’ NHSE wants to clear the elective backlog that it has ‘been responsible for overseeing for the past decade’.
In response to plans to ‘standardise’ referral criteria, he told Pulse: ‘It seems that the standard/default solution is to forever be pushing more and more unresourced work onto general practice whilst simultaneously refusing to acknowledge the important role that general practice has played (and continues to play) in propping up a failing system.’
Dr Janjua said GPs do not ‘have time or manpower to start doing extra work for secondary care’, and whether patients are ‘fit or optimised for specialist procedures is not the remit of the GP’.
South Staffordshire LMC chairman Dr Manu Agrawal told Pulse that GPs ‘should be free to refer any patient who they clinically deem suitable, with hospital investigations staying with the hospitals’.
He said he thinks the idea to standardise referral criteria, including for pre-referral tests, might ‘help the trust and hospitals’ which are ‘constantly showing poor productivity levels’ despite funding increases.
But he raised concern that it ‘will create a lot of unfunded work in general practice’ and ‘exacerbate’ current pressures.
On advice and guidance, Dr Agrawal said the £20 per request ‘does not reflect the amount of work’ A&G generates for GPs.
‘I think LMCs and GP colleagues will have to go through the details with a very fine tooth comb to make sure it doesn’t completely break the already fragile state of general practice,’ he told Pulse.
NHS England’s national clinical director for elective care Mr Ian Eardley said: ‘The standardisation of referral pathways in the Elective Reform Plan will ensure that every patient has equal access to onward care according to clinical need. And by triaging in a consistent way, we are allowing patients to receive timely diagnosis and treatment.’
GPs continue to raise concerns about ‘workload dump’ from secondary care and other providers, with LMC leaders recently voting in favour of a motion which told practices to avoid using ‘workload dump’ A&G pathways.
London GP leaders claimed in August that workload dump is impacting practices’ ability to deliver safe care, while in Humberside, the LMC has previously estimated that over £4m of NHS funding is wasted on ‘interface’ issues between primary and secondary care.
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So, are the appropriate Royal Colleges (RCS, RCP, RCR, etc) aware that the NHSE considers none of their Consultant members capable of triage and appropriate management of referrals from GPs ?
GPs need to implement their own criteria then, set at 2 standard deviations below the mean of GP competence in each speciality, as we can’t all be above average in every competency.
I suspect there would be a vast gap between what hospital teams and GPs think should be possible to be referred.
Consultants worry about GPs that do not refer. This is a dangerous move for patients. Some things need to be seen by the consultant.
Dear Consultant
Do you own damn job. God knows there are too many of you now
Yours Sincerely
Dr Fedup
GPs should refer when it’s appropriate or the scope of their competency has been exceeded. This looks like scope creep and is dangerous. In addition, if further investigations are required prior to the patient being seen in secondary care, there is no reason why the required tests can’t be arranged by the consultants including any specialist tests outside of my ability to interpret. My job is and should be to decide if a referral is needed or not and investigate to get to that point and refer onwards to the correct speciality. My role is as a gatekeeper and this constant left shift reduces my appointments to do what I trained to do.
I can’t seem to find this expensive committee’s evidence based approach and recommendations on standardisation of discharges that would improve patient outcomes and on costs………. hmmmmm.
hospital medical staff GM 60% increase since 2010 gen Suerg up 38% Radiology up 71%
GP down 12% same period
Case closed