Approximately one-quarter of patient referrals to hospitals are being rejected and sent back to general practitioners (GPs), according to a recent survey. More than a third of these returned referrals, termed 'bouncebacks,' require GPs to undertake tasks considered outside their usual remit. This practice is leading to anxieties among some GPs that it could cause delays for patients suspected of having cancer.
The survey, which polled 712 GPs and was published in the healthcare magazine Pulse, found that doctors estimated 26 percent of referrals were returned under the category of advice and guidance (A&G), even when unsolicited. The A&G system is intended for GPs to seek specialist advice before making a formal referral, but its misuse in these instances means patients who were meant for hospital consultation must instead return to their GP for specialist input.
One GP in London described the system as becoming "more risky and unsafe" and cited it as a factor in their decision to leave general practice. Additionally, family doctors reported that 36 percent of the A&G communications they received necessitated work beyond their standard scope. A GP in the North East warned that A&G is creating "increasing barriers to two-week wait gastrointestinal referrals" for patients presenting with red-flag symptoms indicative of cancer.
Dr. Clare Bannon, chairman of the GPs committee at the British Medical Association, stated that hospital trusts are contractually obligated to accept referrals from general practice, with very few exceptions. She emphasized that referrals should not be rejected with requests for additional GP actions unless it aligns with a locally agreed pathway.
A spokesperson for the Department of Health and Social Care commented that the A&G model has helped millions of patients receive care in the appropriate setting without needing to join elective waiting lists, thereby facilitating more timely and suitable care in primary and community settings.