GPs will be urged against referring patients to hospital specialists and consultants, and some outpatient appointments will be axed, as part of a controversial programme of NHS “rationing” to be introduced in London.
Health chiefs hope the programme, which will affect millions of Londoners, will plug a gaping hole in healthcare budgets by saving more than £60m in the next few months.
The sweeping changes, some of which will take effect immediately, will affect essential hospital care rather than treatments sometimes considered more peripheral. They include significantly reducing referrals to consultants, axing some outpatient appointments and replacing them with a phone conversation, and urging GPs to find “alternative ways” of dealing with patients who need hospital referrals.
The changes were communicated in a letter from the North West London Collaboration of clinical commissioning groups (NWLCCCG), which funds NHS health services for more than two million Londoners, to key individuals including local MPs just under two weeks ago – on the same day the prime minister reinforced his commitment to funding the NHS while announcing he was suspending parliament.
It refers to a financial recovery plan and admits that “some ideas, especially those affecting patients, will generate strong views and we will need to make some difficult choices”.
The new cuts list includes:
Patients currently receiving treatment from more than one consultant may no longer be able to access treatment from both or all of the specialists.
“Repatriation” of some acute treatment from various specialist hospitals to local ones.
New scrutiny – described as “demand management” – of GPs who refer patients for acute treatment, with GPs being asked to look at “alternative ways” of dealing with patients’ needs.
Reduction in intravenous feeds through “better prescribing”.
Hammersmith MP Andy Slaughter described the news of major cuts to essential NHS services as a crisis. Gareth Thomas, the Harrow West MP, said the new plans amounted to rationing.
Medical experts warned it was important GPs did not feel pressurised not to refer patients to hospital against their expert judgment, simply on the basis of cost.
Dr Gary Marlowe, BMA London regional council chair and London GP, said that while the financial pressures that clinical commissioning groups (CCGs) were under was appreciated, “cost-cutting must not come at the expense of quality patient care or increased bureaucracy and workload for doctors”.
He added: “All clinicians – whether in GP practices or in hospitals – must be able to make decisions over what is best for the patient in front of them, based on their own clinical evidence base, and not be blocked by arbitrary money-saving restrictions.
“By restricting referrals – be that from GP to hospital, or between consultants – patients are prevented from receiving the best treatment for their individual condition.”
North-west London has previously been the testing ground for major NHS blueprints across the country, such as Shaping A Healthier Future, a failed hospital closure programme which wasted £76m on management consultants alone.
Health campaigners fear that the cuts to essential NHS acute services contained in the list could be rolled out nationwide to deal with budget shortfalls. There was a large overspend nationally in 2018/19, although the £112m projected overspend for this financial year in north-west London is likely to be among the highest for one NHS area.
The expected overspend for 2019/20 in north-west London was previously £51m, but this has more than doubled with a further £61m identified – a total of £112m. Health chiefs say this is mainly due to spending on acute and continuing healthcare.
The document states that there is an “opportunity to significantly reduce consultant-to-consultant referrals, follow-ups and outpatient procedures”.
Slaughter said: “This is what the NHS in crisis looks like. A deficit more than doubling in the course of one year leading to swingeing cuts in basic clinical services.
“GPs are being told not to refer patients to consultants unless absolutely necessary and then only to those at the local hospital trust where waiting times could run to six months or more. The restrictions on consultant-to-consultant referrals will hit those with the most complex and difficult conditions hardest.”
Prof Martin Marshall, the vice-chair of the Royal College of GPs, said: “GPs are keen to work with CCGs but what is paramount is that any initiatives do not lower the standard of care that patients receive … it is important that GPs do not feel under pressure not to refer against their expert judgement on the basis of cost, or because they are concerned they will be penalised in some way.”
Health campaigner Merril Hammer, secretary of the Hammersmith and Fulham Save Our Hospitals campaign group, said: “These budget cuts should ring alarm bells more widely. If these cuts to services go through in north-west London it seems inevitable that similar cuts will be imposed across the country.”
A spokeswoman for NWLCCCG said: “Some of the proposals that emerge will see changes to patient services. We will engage patients as plans develop but as with any change there will be people who do not agree with our proposal. Some ideas will affect clinical services and in putting forward our plans we want to emphasise that the safety of our patients and the quality of our services will always come first.”
The spokeswoman added that they would ensure no patient waited more than 52 weeks for treatment. She said that referrals to consultants in different specialties would continue “within agreed pathways” but that “inappropriate referrals” would be stopped.