Many PCTs have reportedly been considering or actually putting these in place. This reflects some generalised mention of CRS as a potential tool in DoH documents. Some anecdotal negative reports were received by BOS about their implementation and effects. BOS therefore surveyed all members in 2009 to gather some more robust, detailed and representative facts. All members were circulated by e mail. The core results were as follows:
- Blackburn
- Oxford
- Cambridgeshire
- Somerset
- East Lancs
- Southampton
- Hampshire
- Suffolk
- Kingston
- Thameside
- Leeds
- West Sussex
- Norfolk
- 2 sites not given
- These 15 locations (17% of all replies) had a CRS of some type in place.
- Bournemouth/Poole
- Oxfordshire
- Cumbria
- Plymouth
- Derbyshire
- Wolverhampton
- Dorset
- Dorset (west)
- 2 not given
- These further 10 locations were considering setting up a CRS
- In a further 12% of locations, a CRS had been considered but rejected
- In 50% of instances where a CRS had been implemented, there had been no consultation with local clinicians or through a MCN/LCN.
- In 75% of locations where a CRS had been implemented, the clinicians did not feel it had been a positive or useful step, with many feeling that it had been counterproductive in terms of enabling better care or better purchasing.
NOTES: Those areas where a CRS had been implemented were contacted for further details, and whilst some were provided, the data remains incomplete in some important aspects, such as the exact purpose of the CRS, what type of person (e.g. clerical staff or clinician) was carrying out the central assessment, the extent of any added delay and any change in the routeing of referrals.
A general comment is that in areas where a contract had been awarded to a clinician for ‘triaging’ of referral this was viewed very negatively as being expensive, duplicating of clinical time and payment and not resulting in appropriate provision of care in terms of geography or type of provider (eg hospital or specialist practice orthodontics). It is seen as open to conflicts of interest.
In other areas, where the CRS was simply focussed on gathering postcode and other simple data about referrals, then the view was more neutral or even positive. In some of these areas, it was seen as understandable that the PCT might wish to reassure itself over a finite time period about the reported patterns and numbers of referrals. In some of these locations there was a disappointing delay in processing referrals.
Areas with the most negative view and biggest disruption of good clinical care were frequently those with poor relationships between clinicians and PCTs or no MCN/LCN and where there had been little or no consultation.
Summary:
- A CRS is in place in a small minority of locations. The scope, nature and intentions of the CRS vary widely.
- Most but not all views were negative about the effects and value of a CRS.
- Sharing this information may be helpful to any location where a CRS is being considered.
- BOS should again approach those areas with a CRS later in this year to add to the available information in the light of further experience
NWTH
Chairman of BOS March 2010
