Will “optimisation” make things better: Brent’s new referrals service

In the real world “optimisation” means making things better. In “NHS speak” you can’t be too sure.

Brent CCG has contracted Bexley Health Ltd (BHL) to provide a Brent ‘Referral Optimisation Service’ (BROS). This will start on 1 September 2016. Brent Patient Voice has followed this development for several months. We think it could have some advantages for patients and GPs but these now appear to be heavily outweighed by its serious disadvantages.

From 1st September all Brent doctors’ referrals of patients for specialist investigation or treatment must be sent through BROS including hospital Consultant to Consultant referrals. The BHL website claims that this referral management service will produce an improvement in the overall quality and completeness of referrals and a reduction in unnecessary and inappropriate referrals which will improve both the efficient use of NHS resources and patient’s time.

It is clear to us that this new Service will play a keystone role in the Brent Sustainability and Transformation Plan for transferring much hospital speciality out-patient referrals to new cheaper community services run by the single proposed new GP Brent Care Ltd ‘Alliance’ of all 66 GP practices.

The new referrals service is to be financed entirely by Brent CCG taking about £3 million per year out of its healthcare leaving an extra healthcare “savings” of about £2 million a year after using £1 million per year to pay for the new referrals service.

We have serious concerns about Brent CCG attempting to impose new restrictions on patient choice with this service. NHS Improvement (the re-named NHS Monitor) issued new guidance for CCGs on 16 August 2016.

We also have serious concerns about Brent CCG attempting to reduce GP’s clinical independence to refer their patients to the hospital services that they believe best for the patient.   The referrals optimisation service will never have met the patient and not have access to the patients full medical history.

Our concerns about this service have been greatly increased by Brent CCG at the last moment pulling out of a meeting arranged by the independent statutory Local Medical Committee (LMC) on 16 August 2016 to which we had been invited. Brent Patient Voice had given Brent CCG notice of our questions. The CCG have not offered any new date for this meeting, and we are just told indirectly through the LMC told that ‘they will instead address your queries and concerns through their patient engagement structures’ without any date suggested.

On 16 August we wrote a strong letter to Brent CCG protesting at their failure to answer our questions, and pointing to their statutory duty to involve Brent Patients and public in their proposals for their healthcare commissioning and changes to it that affect patients. Our letter has been acknowledged saying they hope to reply by 1 September.

Our worries about the BROS have been increased by the report by Caroline Price on 17 August in Pulse that a 6 week urology pilot ROS by NE &W Devon CCG has resulted in 142 (30%) of GP referrals being sent back to the GP mostly to carry out more investigations themselves such as ultra-sound scans – for which the GP’s complain they will receive no extra pay.


Peter Latham.


21 August 2016

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