Your article (GPs told to minimise referrals to plug London budget hole, 9 September) wrongly suggests that we have a plan to “ration” access to special referrals.
We have written to local GPs to say that so far this year, we have been spending beyond our allocated budget. We are trying to contain this overspending, not by rationing referrals but by ensuring that they are all appropriate and within clinical guidelines. As part of this, we are suggesting that where possible, referrals should be made in north-west London. These are not “cuts” to existing provision but an effort to stem unexpected growth in activity that could ultimately put services in the area under intolerable pressure. Many of our patients currently end up in hospital when they do not need to be there or attending outpatient appointments that they do not require.
As you report, all parts of the local NHS are developing a financial recovery plan to address our long-term underlying deficit. Local clinicians will work with local people and patients in making decisions around this.
Mark Easton Accountable officer, North West London Collaboration of Clinical Commissioning Groups
Lesley Watts SRO, North West London Health and Care Partnership and chief executive, Chelsea and Westminster Hospital NHS Foundation Trust
• The move to minimise referrals is a further interference with GPs’ ability to use their clinical judgment and knowledge of each patient to make a decision in that patient’s best interest. Some areas already have restrictions on GPs choosing the most appropriate consultant in each case. It is not surprising that they are becoming frustrated by such rulings and seeking early retirement in increasing numbers. If those in authority seriously want to cut costs, they would do better to look at simplifying many aspects of the system and reduce unnecessary bureaucracy by abandoning the wasteful competitive market system.
Peter Fisher
President, Doctors for the NHS
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