National GP referral guidelines are needed to reduce inequalities

This pattern suggests the worst possible outcomes at both ends of the spectrum: healthier, wealthier patients treated too soon to bring about an improvement; poorer, sicker patients treated too late to benefit.

PCTs must ensure GPs in deprived areas carry out the screening necessary to identify those needing treatment before it is too late

The underlying causes are manifold. People in deprived areas have poorer health, are served by fewer GPs and are less likely to go to their doctor or be diagnosed if they do. Those in richer areas are more likely to bang on their GPs’ doors at the first sign of a problem and insist on an operation.

GPs seem to be too often giving in to this pressure, even if the knife is not the most beneficial course of action. Once patients have been referred, there is often no going back.

Without change, healthcare providers in poorer areas will continue to be financially penalised for treating sicker patients who potentially require longer stays, while in richer areas, primary care trusts and providers are bearing the costs of inappropriate elective referrals.

PCTs must ensure GPs in deprived areas carry out the screening necessary to identify those needing treatment before it is too late. In richer areas, GPs must be required to explain alternative treatment options and likely outcomes in full.

National referral guidelines like those produced by the National Institute for Health and Clinical Excellence for cancer would, no doubt, prove contentious - GPs may bristle at the perceived insult to their judgement, sharp-elbowed patients would complain at being turned away.

But if developed with the involvement of patients and royal colleges and policed fairly by clinicians, national guidelines could improve information for patients, reduce disparity in treatment and, significantly, potentially save the NHS millions of pounds.

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