The need to reduce costs incurred by the UK’s health system has been growing in recent years, given a rapidly aging population and the pressure that has placed on hospitals and staff. A number of initiatives have been set in motion to help curb spending, but some have a noticeable effect on the quality of care patients can expect to receive. One of these cost-saving techniques is the implementation of referral management systems – in-hour or third-party arrangements that, in theory, work to reduce the number of unnecessary referrals to hospitals and specialists by way of an in-depth review. The use of referral management systems throughout the NHS has grown significantly in the last five years, and while the mission is to eliminate expenses, patients are not receiving the care they need to correct common conditions like varicose veins.
The initial intent of adding referral management systems to the NHS was to remove medical conditions of low clinical priority from the queue of referrals passed on to hospitals, saving money in the process. Varicose veins represent a condition which has the potential to be deemed low priority by GPs around the region, based on a scoring system of severity. Ranging from 1 to 6, with a rating of 1 being the most minor occurrence of varicose veins and 6 representing the most severe, doctors and surgeons are told not to add patients on the operating list to correct varicose vein issues unless the severity grade exceeds 3. It isn’t surprising that veins graded 1 and 2 are not referred to a vascular surgeon or hospital through referral management systems, given the biggest complaint about these varicose veins is not pain or discomfort, but cosmetic dissatisfaction. However, the growing group of patients experiencing grade 3 varicose veins are often denied referrals to fix their varicose veins, even when there is ongoing swelling, aching, and itching surrounding an affected vein.
Modifying Severity Guidelines
A leading vascular and vein surgeon in London, Eddie Chaloner, explains the problem presented to patients who are experiencing issues with varicose veins. He states that referral management systems came into play as primary care trusts, established to run groups of GP practices, paid hospitals each time a patient was referred. To put a lid on costs, referral management systems were implemented in several locations to effectively reduce the number of appointments that were not deemed a priority. In practice, however, patients with complex issues like varicose veins are forced to go back and forth in a GP-specialist limbo, through the referral management systems, in order to receive appropriate care.
As primary care trusts shift toward adhering to modified guidelines of varicose vein severity, the lines are blurred for those patients who fall into the grade 3 category of pain and discomfort. Individuals with uncomplicated vein issues represent nearly 60% of total patients seen for varicose veins, and they are now not allowed to be seen in a hospital setting due to referral management system declines. The ethics of this practice are called into question given the delays in appropriate care based on the inclination of someone with professional medical training at a referral management centre. Patients could experience an ongoing decline of their varicose vein issues if the reliance on referral management practices continues to grow.
What Patients Can Do
For less severe varicose veins, as experienced by those with grade 1 or 2 issues, there are some remedies that work to reduce the look and feel of bulging, twisted veins beneath the skin. Most utilise compression stockings, which place external pressure on the calves and lower thighs in an effort to increase circulation and blood flow. Additionally, participating in physical activities that are low-impact, like walking or swimming, help reduce marginal discomfort when varicose veins are present.
Referral management systems are helpful in reducing the cost burden placed on hospitals throughout the UK in theory, but in practice, they may be missing the mark. If patients are forced to go through the process of receiving a referral multiple times before they can receive the care they need, referral management centers are in effect increasing, not reducing, the cost of health care across the board.
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