GPs hit out at new rule limiting referrals to specialists

Personal doctors (GPs) and patients have hit out against the trimming of the number of referrals to specialists within the healthcare system, following changes made earlier this year to crackdown on misuse.

Doctors have complained that they are being prevented from fulfilling their duties to the fullest as they face sanctions should they exceed 66 referrals to specialist doctors per 100 patient visits.

There have been complaints that this has led to patients with chronic illnesses, although not urgent, being told to delay their appointments in case their GP is likely to exceed the monthly ‘limit’.

Patients across the spectrum have complained that they are being told by their GPs that they are not allowed to issue any more referrals at that specific time. That means patients must wait another month to get the referral or pay €25 for their visit to a specialist or for certain tests.

A major overhaul was made over the summer which altered the criteria for which doctors are paid.

Pay is no longer exclusively per number of patients – this now accounts for 80 per cent, with the remaining 20 per cent linked to quality criteria.

That quality control aspect is strongly based on the number of referrals issued by GPs for specialist doctors, tests such as x-rays and MRIs as well as lab tests.

But GPs have complained that they are being docked their full renumeration when exceeding the threshold of referrals, without any follow up checks being made to ensure that their additional referrals were valid.

The updated requirements have themselves been criticised, such as not adequately differentiating between patients requiring referrals for long-term health conditions and others with more immediate or sudden ailments.

Kostas Schisas, a GP, told Politis that patients with chronic health conditions should be able to receive direct access to specialist services – rather than requiring a referral from their GP. Those types of referrals are lumped in with the rest of the referrals that a doctor is entitled to issue.

He gave the example of heart and cancer patients who must renew their referrals by their GP every six months. Elsewhere, he argued that part of the available pool of referrals are being depleted because patients who require medicines not prescribed by GPs must obtain a referral to see a specialist.

Marios Kouloumas, head of the federation of patients’ association, also complained over the change to the system as regards referrals – saying it does nothing to ensure quality control.

He decried a ‘soft cap’ on referrals being used to assess quality care, saying that doctors who remain under the limit are still prone to misuse.

“Quality control must be ascertained through checks, not by placing a cap on the number of referrals,” he argued.

Kouloumas further emphasised that a core tenet of Gesy is that GPs are fundamental to its success, adding that we should support them and allow them to do their job without placing unnecessary limitations

For its part, the HIO has argued that the correct operation of the system of personal doctors will ease pressure on specialists who receive too many unnecessary referrals.

The organisation also stated that the changes will lead to the more effective use of resources, safeguarding equal access to health care professionals for those that need it.