"Is the NHS trying to cut costs here?"

About: Devon Access and Referral Team (DART) Royal Devon and Exeter NHS Foundation Trust

(as the patient),

I'm not happy with the referral system for both myself and my wife. My wife was referred for an endoscopy - got an appointment through, but it was made with a consultant not the endoscopy department, so has to go through the whole process again. I thought that was badly organised as we have to go back to our GP again. In my opinion this was not well thought through.

For me - I'm 74. I have varicose veins - the doctor referred me but they put it off. I got referred again, but they cancelled it because they thought I wanted the treatment for cosmetic reasons. I am concerned that they could knock back my GP's referral like this.

Is the NHS trying to cut costs here? I can't understand why they would think a 74 year old man would want cosmetic treatment. After years of suffering, I want them to be treated and not left so long. When you call, it would be good if they had your patient records in front of them so they know your background. I'm not at all happy with this system. I've lost months through mistakes with referrals - it's painful.

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Response from Susan Pearce, Project Support Manager, DART (Devon Access & Referral Team), NHS Devon

Dear ‘energy795’,

Thank you very much for contacting us to let us know about your experience of using DART. I’m very sorry to hear that you are unhappy with the service and apologies for the delay in my response.

Regarding your wife’s referral; I cannot comment fully without more details, however, something was clearly amiss and I’m dreadfully sorry that her time was wasted by having to attend an appointment needlessly and ended up going back through her GP. This is also a waste of NHS resources which we obviously prefer to avoid. If you wanted to call me on 01626 883888, I would be quite willing to investigate the details of your wife’s case and see if I can identify the problem in order to give you a better answer.

Regarding your own referral for varicose veins, a policy for referral has been in place for many years across the region as it is a condition that is not felt to be a clinical priority. The DART team send any referrals which do not clearly meet the criteria in the policy back to the referring GP. The GP then has three options:

1. Resubmit the letter with additional information if they feel that the patient does meet the criteria.

2. Ask for the Restricted Treatments Funding Panel to review the referral

3. Discuss other treatment options with the patient

Here is an extract from the policy:

The South West Peninsula Health Community (which includes patients from NHS Devon, NHS Plymouth, Torbay Care Trust and Cornwall & Isles of Scilly PCT) has developed a policy to cover treatments and interventions which have little or no clinical priority.

The policy states:

It has been agreed that the highest priority for funding should be placed on those health services which support patients with life threatening illness, chronic long term illness or disability, or patients who only have a short time to live.

In order to ensure that good quality services are available to those patients with the greatest need, it is necessary to restrict the funding of treatments which have little, or no, clinical priority, such as surgery for cosmetic reasons. Varicose Veins is included in this policy

Where the patient does not meet the criteria for referral (in the case of varicose veins – bleeding, ulceration or 2 or more episodes of thrombophlebitis) a mechanism exists for an individual’s particular circumstances to be considered which would give grounds for funding treatment in an individual case. In these circumstances, the General Practitioner is required to provide details of the patient’s medical condition and treatment to date and demonstrate that

• The patient is significantly different to the general population of patients with the condition in question


• The patient is likely to gain significantly more benefit from the intervention than might be normally be expected for patient with that condition.

The cases are considered by the Restricted Treatments Funding Panel.

Finally, we do not have patients’ past medical history in front of us it would not be appropriate for the DART team to have access to this information. Your GP will include any relevant history in his/her letter to the consultant so the hospital staff will be aware of everything that’s necessary.

I hope that this answers your questions sufficiently but if not, please feel free to contact me on the number below.

Kind regards,


If you would like to talk to someone at DART about any remaining issues with your referral you can contact our Choose & Book Helpline on 01626 883888.

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