NHS England says GPs to continue to refer patients to secondary care

20 April 2020

NHS England has announced that guidance will be published shortly advising secondary care to "accept and hold clinical responsibility for GP referrals", and that GPs should continue referring patients despite the current restrictions on elective care due to COVID-19.

This guidance follows NHS England's advice to hospital trusts, issued on 17 March, saying they "should assume" they will "need to postpone all non-urgent elective operations from 15 April at the latest, for a period of at least three months".

However, in a bulletin to GP practices sent on 16 April, NHS England stated: "NHS guidance will be published shortly advising secondary care to accept and hold clinical responsibility for GP referrals. Therefore, GPs should continue to refer patients to secondary care using the usual pathways and to base judgments around urgency of need on usual clinical thresholds (taking into consideration need for non-face to face consultations, likely delays in recommencement of routine elective activity, and communicating likely delays to patients at point of referral)."

NHS England also said GPs should take advice from specialists "where available" in the instances when they need to manage the care of patients who are awaiting secondary care review". The bulletin added: "GPs should continue to use specialist advice and guidance where available to inform management of patients whose care remains within primary care including those who are awaiting review in secondary care when appropriate".

NHS England stressed that colleagues should work collaboratively across primary and secondary care to ensure the advice and guidance is provided in a timely fashion "to ensure safe care is delivered, taking into account the exceptional pressures which exist across the whole system".

Partners at a local level are advised to agree "clear, consistent processes exist to ensure safe handling of emergent, urgent and routine referrals from primary care".

NHS England Primary Care Medical Director Dr Nikita Kanani recognised, however, that not all GPs are able to refer as usual, with some areas getting "bounce backs". She said: "This will be a clearer direction to the system on what we're doing with referrals".

An NHS Digital spokesperson confirmed to "Pulse" magazine that the NHS e-Referral Service (e-RS) is operating as normal so that GPs can continue to make referrals to secondary care. They stated: "Guidance will be published shortly advising that GPs should continue to make referrals where clinically necessary, through e-RS, and it will include further advice on how e-RS can be used to support referrals in the current circumstances".