Panel to decide who gets vital health checks as decision is taken out of doctors’ hands

The Press has seen a leaked letter, part of which is reproduced below, from managers at North Yorkshire and York Primary Care Trust (PCT) detailing revised proposals to save cash.

Now some decisions on patients are being taken away from GPs and put into the hands of a PCT "prior approval" panel.

Dr David Hartley, chairman of York Health Group, said that could mean people with tumours ended up undiagnosed at an early stage in their disease. "There's a strong likelihood we'll miss something because of this," he said.

The debt-ridden PCT said its plans did not affect urgent or emergency care.

Back to the Dark Ages

DOCTORS have warned patients with cancer could miss vital diagnosis as further details of multi-million pound health cost-cutting emerged today.

The Press has seen a letter sent to the county's GPs by the cash-strapped North Yorkshire and York Primary Care Trust (PCT), which gives further details on plans to save £10 million by the end of March.

Doctors said the proposals went further than previous cuts and could leave patients in severe pain - and even be life-threatening.

Dr David Hartley, chairman of the York Health Group of GPs, said the move was taking the local health service "ten years back into the dark age".

One of the most controversial moves is the decision to suspend for three months a GP's "direct access" to CT scans, which comes in addition to the same proposal for MRI scans, already reported by The Press, and Dexa scans for osteoperosis.

It means that GPs who want their patients to have a scan must first go through a "prior approval" panel run by the PCT.

But doctors said they feared that could mean patients with symptoms not easily diagnosed like long-lasting headaches, which turned out to be brain tumours, could get missed if the panel did not send them for treatment.

Dr Hartley said: "There's a strong likelihood we are going miss something because of this."

Fellow GP Dr David Fair, from Jorvik Medical Practice, said: "People on this approval panel, who may not have any medical knowledge and don't know the patient at all, may be obstructing the medical process which has been started by the patient's own GP, who has knowledge both of the patient and their medical requirements.

"Patients who have a cancer which may be treatable at an early stage may not have it diagnosed until it's reached a stage where it's inevitably fatal.

"There are people who have symptoms that warrant having scans who aren't definitely going to turn out to have cancer. It's a fine judgment to be made that can only be made by a doctor who knows the patient."

A PCT spokesman said there were established mechanisms for patients to be referred urgently if cancer was suspected - and these were not affected by its latest plans.

"We would like to reassure patients that treatment for urgent conditions, such as cancer, remains a priority," he said.

"We are asking GPs to seek prior approval from the PCT for routine CT and MRI scanning so we can ensure these resources are used as effectively and appropriately as possible.

"We are certainly not aiming to stop scans when these are clinically necessary, but we want to understand more about the reasons why a scan has been requested and to ensure the right diagnostic technique is used, as well as avoiding any possibility of duplication.

"Communication between GPs and the PCT will be very important in achieving this aim."

PCT adds treatments to hospital suspended list

THE PCT's cost-cutting proposals also include more procedures to be suspended for the next three months.

The Press has already revealed some operations are being restricted so only cases deemed exceptional can be treated. They included treatment for bunions, ganglions and IVF unless a woman is nearing 40. The latest set of restricted procedures include epidural injections for chronic lower back pain and tonsil operations.

Facet joint injections for chronic lower back pain are also now being stopped indefinitely rather than just for three months.

PCT chief executive Dr Janet Soo-Chung said: "We have been discussing these proposals with a number of partners since before Christmas and are grateful for the comments and advice we continue to receive. We have tried, wherever possible, to take their views into account.

"The PCT recognises the practical detail involved in the prior approval process and we will be working with our GP and hospital colleagues on an ongoing basis to make sure the system we have in place works as efficiently as possible and enables a quick decision to be taken.

"We appreciate the measures we are taking are difficult. Clearly, some patients will have concerns, and it is important for us to stress once again that our plans do not affect urgent or emergency care, which are continuing as normal, nor is there any outright ban on any procedure.

"Tackling the overspend by the PCT is a challenge the whole health community in North Yorkshire and York faces both now and in the foreseeable future."

'This is frankly disgraceful'

The Press spoke to Andrew Lansley, the shadow health minister, who was holding a meeting with local GPs in Bishopthorpe, York, last night.

"I've seen some of the things that have been proposed by the trust and the result of some of them will be deferred treatment," he said.

"Like a number of PCTs across the country, they are insisting that patients be referred via an approval panel.

"We've got a situation where there may be capacity at the hospital, and GPs want to refer patients, but the PCT won't let them. This is frankly disgraceful. Because of the financial mismanagement and financial embarrassment of the trust, these patients won't receive treatment.

"I will be talking to GPs and they will be justifiably upset about judgements on referrals being taken out of their hands.

"Rather than the PCT trying to control what happens in order to get themselves out of this hole, I'd be far happier if the budgets were devolved to the GPs."