Dear Sir,

We are all consultants working at the Royal United Hospital and also undertake private practice in Bath. In this capacity we are writing to voice our profound concern following the unilateral introduction by BMI of a fundamental change to the patient referral process. In the past few weeks, without consultation, BMI has introduced a Referral Management system, which we believe undermines and challenges the Professional Guidance issued by the GMC and other professional organisations within which we all work. In so doing, it fundamentally reduces the quality of care that can be offered to our local patients.

In the GMC publication “Good Medical Practice” the first few lines state “ Patients must be able to trust doctors with their lives and health. To justify that trust you must show respect for human life and you must “Make the care of your patient your first concern.” It goes on to say that “good clinical care MUST include… referring a patient to another practitioner.”

It is the General Practitioner (GP), or another recognised healthcare professional, who advises whether a specialist referral is required. They should also decide the most appropriate specialty and consultant within that field; these principles have been reiterated by the British Medical Association in "Referral Management Principles 3."

 

It is the consultant’s responsibility to advise on the most appropriate hospital for the patient's care. These two principles were included as recently as 2009 in “A Charter for Patients and their Doctors” -  Principles Governing Medical Practice in the Independent Sector ” published by the Federation of Independent Practitioner Organisations (FIPO) and this in turn was endorsed by the Senate of Surgery comprising the Royal Colleges of Surgery and the Federation of Surgical Specialty Associations as well as all the other Royal Colleges, GMC and Patients Association.

Patients and their advisers (referring GP’s or others) need to be confident that this code is ALWAYS practiced in all contacts they have with the profession, and this includes the referral process to secondary care in which we are involved. We have serious concerns that your referral management system potentially compromises this; those working in it are unknown not only to us but also to local GPs. They do not know the details of the exact specialist skills and interests of the consultants working in Bath or indeed anywhere else in the country where BMI is imposing these changes. The traditional practice, which has always worked in patients’ best interests, necessarily allows patients through their GPs to be appropriately seen in secondary care through the direction of consultants’ secretaries without the involvement of a third party. It is for medical professionals and their offices, not remote call centres to accept a referral or re-direct it. This redirection depends on many factors: the patient’s problem, the consultant’s expertise, their specialist interest, the time constraints of the patient. Your referral management staff cannot do this as well as the individual secretaries.

The recent government White Paper has emphasised that the recent approach within the NHS to direct patients to “generic” lists removes choice and quality from the referral process. The white paper makes it clear that in future NHS patients will be given the choice of referral to a named consultant, and that the generic referral process is to be scrapped. It seems perverse that a private sector provider is adopting a directly contrary strategy, the outcome of which will be to potentially offer less choice by the use of systems such as yours than patients in the NHS.

For these reasons, we suggest to you that you are potentially compromising your own professional duties to ‘Make the Patient your first concern’ and request that you make arrangements for the Bath Clinic to be removed from this Referral Management system run by BMI forthwith.

Yours

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