One GP called for the scrapping of schemes which sometimes pay thousands of pounds in incentives to family doctors who cut the number of patients sent to hospital. An experienced surgeon said it was unacceptable for Jeremy Hunt, the Health Secretary, to criticise GP surgeries for not referring people to consultants quickly enough when the situation was the result of the Governments changes to the structure of the NHS. They were responding to new league tables published last week which found that 59 per cent of GP practices in England referred less than half of patients who went on to be diagnosed with cancer within two weeks as set out in national guidelines. Dr Robert Walker, a GP in Cumbria, called for family doctors to be allowed to use their clinical judgment about when to make referrals instead of being forced to follow NHS guidance. Related Articles Half of GPs don’t refer cancer patients urgently, league tables show 06 Dec 2013 In a letter to the Daily Telegraph, he said: For the last five years Primary Care Trusts across the country have introduced what are called referral management schemes. These weasel words actually mean applying pressure on GPs to reduce referral of their patients to specialists to save NHS expenditure. In some cases these schemes offer a financial incentive to lower referral rates. It is the case that very early symptoms of cancer are indistinguishable from those of non-serious illness. If referral to specialist care generally is regarded as bad it is not surprising that GPs may delay until symptoms become more florid. Proposing an immediate ban on referral management schemes, he added: Experienced GPs who know their patients will often have a sixth sense about possible cancer even if the patients symptoms do not fit the referral guidelines they are given. Peter Mahaffey, a surgeon in Bedfordshire, suggested that Government reforms to put groups of GPs, known as clinical commissioning groups, in charge of NHS budgets had made the situation worse. He said in a separate letter: As a specialist who has been receiving referrals from family doctors for 20 years, I have not noticed any decline in GPs caring or clinical skills. What, however, is patently obvious to most consultants is the increasing pressure on GPs not to refer their patients to hospital. This is the inevitable consequence of asking primary care doctors to manage their own constrained budget allocations. Sean Duffy, NHS England’s national clinical director for cancer, said: “All referral decisions must be driven by clinical need. We have not seen evidence that these concerns are typical. Where there is a concern in relation to potential cancer diagnosis, the referral pathways are clear in the presence of red flag symptoms. “CCGs [clinical commissioning groups] are best placed to determine, in the new NHS, what pathways of referral are in the best interest of their population.
20 doctors hired for Pindi BHUs
However, only seven of them have so far joined the health units. As many as 30 posts of doctors in the basic pay scale (BPS) 17 remained vacant for the last one year. During this period, only eight doctors were running the health units in the rural areas on ad hoc basis. After recruiting 20 doctors through the Punjab Public Service Commission (PPSC), the government put their services at the disposal of the district health department. Furthermore, the government also regularised the services of eight doctors who were working with the department for the last one year. A senior official of the health department told Dawn on Sunday that most of the doctors were not willing to work in the rural areas. As a result, only seven have so far joined their duties. The department will wait for the doctors till next week and after that will send other names for appointment, he said. The official added that there were 78 dispensaries in the city areas and 15 posts of doctors lying vacant for the last two years. As many as 17 doctors are running 78 dispensaries and the patients have to go to government hospitals which are already crowded. He said senior laboratory in-charges were running most of the dispensaries. The issue has been brought to the notice of the government but to no avail, he said. When contacted, Executive District Officer (Health) Dr Zafar Iqbal Gondal said the provincial government had regularised services of eight doctors and appointed 20 more for the rural areas. Total 30 posts were vacant and all of the appointees came through the PPSC, so it took time for their appointment, he said and added that the new appointees would join their duties soon. Former Chairman Young Doctors Association Punjab Dr Mohammad Haroon told Dawn that there was a difference between the facilities provided to doctors in rural and urban areas. The salary is the same but the urban area doctors enjoy facilities of allowances. In city areas, there is no issue of transportation but in the rural areas doctors must have their own transport or hire taxis, he said.