‘Out of their depth’ nurses block GPs’ patient referrals to hospital for treatment
Patient whose hip was constantly dislocating was refused surgery by a nurse
One man was even denied a hip replacement – although his hip was constantly dislocating.
Doctors have criticised NHS trusts for hiring non-doctors to overrule the decisions of more qualified GPs.
An investigation by Pulse magazine found that several trusts are are using nurses, podiatrists and physiotherapists to determine whether referrals made by GPs are appropriate.
The ‘referral management centres’ which review referrals by doctors have proved controversial after it emerged they block some GPs’ referrals to save cash.
In February, Pulse revealed that one GP in three had their referrals screened by a referral management centre, while up to one in eight referrals is rejected.
The treatments denied to patients included hip and knee replacements, cataract surgery, allergy care, IVF and tonsillectomy.
Five – NHS Bournemouth and Poole, NHS Hertfordshire, NHS Manchester, NHS Oldham and NHS Plymouth – said they used non-doctors to assess GP referrals.
NHS Manchester uses two podiatric nurses and a non-medical prescriber with a diploma in podiatric medicine to triage GP referrals for vascular conditions.
In NHS Oldham, more than a third of its staff screening GP referrals in ophthalmology, diabetes, urology and musculoskeletal conditions are non-doctors, according to the study.
GP Dr Andrew Mimnagh, from Merseyside, told Pulse he knew of instances elsewhere where ‘patients had come to harm from not being referred’.
He said: ‘Nurses assess patients according to rigid criteria and do not have the experience to make flexible decisions in the same way a doctor can.
‘In one case, a patient was rejected for a replacement hip operation by a nurse at a referral centre despite the fact his hip was dislocating. According to the nurse’s criteria, he wasn’t reaching a high enough pain threshold because he already had an artificial hip that cured the pain.
‘Nurses do not have the knowledge to know when they are out of their depth.’
A spokesperson for NHS Oldham said: ‘Nearly all GP referrals go through a referral gateway, run by local GPs.
‘There are some areas where we’ve had multidisciplinary teams in place for some years. They are people with the appropriate clinical skills and experts in that specialty.’
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