The real reasons behind doctors’ hospital referrals

From Dr Bryony Perchard.

I WRITE on behalf of the Jersey Primary Care Body, the organisation which represents the Island’s GPs. We were extremely concerned to read in the recently published addendum to the Verita report the allegation that local GPs refer patients to hospital consultants for financial reward.

We would like to reassure our patients and the public that this is entirely incorrect. When a GP makes a referral to the hospital, he or she receives £15 from the Department of Employment and Social Security and additionally may make a further charge to cover the doctor’s time in preparing the referral (ensuring that the appropriate clinical information is disclosed, such as the scope of the problem, pre-existing medical problems, medications, allergies etc), together with secretarial fees, postage and all other costs associated with generating a letter.

A recent audit showed these costs to be in the region of £30 per referral. No financial gain is made, there being no additional incentive payment for the task.

Having reviewed the otherwise excellent and extensive report, the initial referral by Elizabeth Rourke’s GP, Dr Wilson, was reported as entirely appropriate. Section 7.4 of the main Verita report states: ‘This was an entirely proper action for Dr Wilson to take. He could have offered Mrs Rourke treatment to try to help with her symptoms, but seeking an expert opinion was appropriate because it might help to decide what treatment to offer.’

The statement made in the addendum of the report suggests that according to the subjective view of some hospital staff, Jersey GPs make higher than the UK average referral rates to the hospital. Should this be the case – and there is no objective evidence disclosed in the report – this may be for a multitude of reasons.

GP referrals to the Hospital do highlight one of the problems associated with Jersey’s health care system that may contribute to the suggested higher than national average hospital referral rate. Unfortunately, patients have to pay to see their GP, but they do not have to pay to see a consultant (although they do pay through their taxes). As a result of this system, GPs are sometimes under pressure by patients to refer to the hospital.

It may be the case that the problem could have been dealt with by the GP practice, but this would obviously incur ongoing costs to the patient.

Therefore, there is an incentive for referral from some patients who may be struggling with their medical bills and would like to be seen in the ‘free’ hospital rather than by their GP. This may result in a GP practice losing income by referring patients to the hospital, rather than gaining any.

As GPs, our primary concern is to promote the best interests of our patients, having made a clinical assessment of need, coupled with their concerns and expectations.

Residents of Jersey are used to having good access to the Hospital and being able to see consultants promptly. As the population increases, and with it expectations of improved health, this will put the Hospital under more pressure. This will be increased by the ageing population. We are very willing to contribute to efforts by the States to resolve some of these issues and are in consultation to improve medical care provision in the Island.

We hope this letter goes some way towards reassuring our patients. We look forward to the States and Hospital authorities promptly addressing the recommendations of the Verita report and would welcome the opportunity to meet Verita to discuss the concerns that have been raised.

We are committed to improving the health of the Island, and strive to avoid such a tragedy happening again.