Outcry as Latham House ends its internal referral system

Previously, and for many years, patients could be referred internally to see a specialist at Latham House if it was required, giving them easy access to local services in Melton.

The practice, which currently has 35,700 patients, had managed to continue to provide its internal referral system despite the East Leicestershire and Rutland Clinical Commissioning Group (ELRCCG) ending its funding of the service in 2012.

But Latham House bosses said that because the practice was now receiving even less funding from the ELRCCG, due to contract changes, it had been forced to ‘make some difficult choices’ and ‘reconsider its funding work’ including ending its internal referral system.

The move has already led to complaints from angry and worried patients now faced with the inconvenience and cost of having to travel to hospitals outside of Melton if they need to see a specialist in departments such as cardiology, ear, nose and throat, ophthalmology dermatology and endoscopy.

Leicestershire county councillor for the Melton south division Alan Pearson is a Latham House patient and member of the practice’s patient reference group. He’s shared his concerns about the ‘potentially massive impact’ the changes will have on patients with health officials as well as fellow county and borough councillors.

He said: “The decision to cut back support on internal referrals at Latham House is beyond doubt one of the most poorly thought out cost-saving concepts possible.

“Imagine a GP organising an appointment for an 80-year-old to go to Leicester Royal Infirmary for specialised treatment when the same expertise is six feet away in an office next door at Latham House.

“Many of the patients who require complex treatments are the elderly. They will have the problem of accessing transport to appointments either in Leicester, Loughborough or Oakham. The public transport from Melton to Rutland, Loughborough and Leicester is limited. There’s also the additional cost for patients to access transport – who would pay for this? For those who need support with transport – who is going to provide it?

“I’m also concerned about elderly patients being put at risk due to waiting longer than necessary for appointments away from Melton. This could cause their condition to deteriorate, potentially requiring the patient to be admitted to hospital which would be at great cost to the NHS.”

He added: “Melton Mowbray is lucky to have such an excellent service as Latham House but the reduction and destabilisation of services will risk patient care and cause unnecessary inconvenience and barriers to access. “This will invariably have the opposite effect of saving funds. It’s going to cost more money in the long-term. It’s totally a false economy as far as I’m concerned.

“Community-based local services provide the best service. Patients are more comfortable and people like them but now we’re going in the totally opposite direction we should be going in.”

Dr Richard Pemberton, chief executive officer and partner at Latham House, said: “Our view has always been that patient services should be provided locally wherever possible. This is supported by our patient reference group. Local services can be more cost effective and more easy for patients to access.

“The ELRCCG ceased funding our internal referral service when practice-based commissioning ceased in 2012. The practice continued to provide the service, in a reduced/changed manner since that date.

“Due to the contract changes more recently, the practice has had to reconsider its funded work and have asked for services to be recommissioned with us again.

“Patients who need referring for services will continue to be referred and can choose which hospital they will be seen in.

“Our quality of care will not be affected. If a patient needs to see any other clinician, they will continue to be referred.

“The GPs of Latham House are committed to ensuring that the practice provides the people of Melton with a range of high quality services and support. Clearly, should the practice receive appropriate commissioning, the practice would be delighted to reinstate the internal referral system.”

However, the chief operating officer for the ELRCCG, Tim Sacks, said the funding changes for Latham House were down to the practice’s decision last year to change from a personal medical services (PMS) contract to a general medical services (GMS) contract after a national directive to all PMS practices.

He said: “We acknowledge and recognise how much people value local services and care closer to home so we’d like to make it clear that patients in Melton who need a referral to see a specialist, can be referred to the hospital of their choice, including the Melton and Oakham hospitals for a number of services.

“Practices who wished to revert to GMS contracts had two options regarding the funding they had received under the PMS contract (known as premium monies) - to put forward a business case to illustrate why they would keep the monies, for CCGs/NHS England to evaluate and make a decision on, or give up the premium over a five-year period.

“Latham House chose to give up funding it over a five-year period. This was finalised and agreed with the CCG in March 2015. However, we took a view that losing the money in year one (2015/16) would put patients at a disadvantage as there was insufficient time to allow practices to plan how they would reconfigure their services. With this in mind, all PMS practices received full funding in 2015/16.

He added: “To date Latham House is still in receipt of a significant level of PMS funding and a proportion of the money remains available until 2020/21.

“It is important to note however, that the internal referrals service was actually decommissioned in 2012 by the Leicestershire County and Rutland Primary Care Trust (PCT) after a review of the service found that the number of patients referred to hospital specialists, over and above the internal referrals, had not been reduced by the scheme and was therefore not cost effective. The internal referrals service was decommissioned in order to make better use of the funds in providing services to patients.

“This service from Latham House was due to cease in April 2012 and the funding was stopped at that point. We believe however, that since then Latham House has chosen to redirect other funds to continue to operate an internal referrals service but has recently decided to stop it.

“We will be presenting a paper at our primary care commissioning committee meeting on June 7 which will detail the issues and discussions so far between ourselves and the practice. The papers from this meeting will be available on the CCG’s website.”