The level of bureaucracy involved in referring patients to specialist care in England “is too much to deal with”, doctors say.
Politicians in Westminster are exploring the state of border healthcare between England and Wales to see if lessons can be learned on both sides.
Last year the Secretary of State for Wales, Jo Stevens, and Wales’ First Minister Eluned Morgan announced plans for greater NHS co-operation to bring down waiting times.
Written evidence from the British Medical Association (BMA) in Wales to the Welsh Affairs Select Committee highlighted the frustrations and difficulties consultants experience when referring their patients to services over the border.
The doctors’ body said Wales “lacks many specialist services which can be accessed in England, but the ease of such access can be hugely variable”.
It added that the bureaucracy can be “extremely time consuming” and some consultants have received requests for a second opinion, yet “the reason for the patient referral to a specialist service in England is because such local opinion/expertise does not exist”.
The committee will hear evidence on Wednesday from Dr David Bailey, former chair of the Welsh council at BMA, and Dr Stephen Kelly, chair of the Welsh consultants committee, pointing to a disparity in the quality and timeliness of care when referring patients onto secondary care.
That can even arise in the way data is gathered, as patients referred to English trusts “can be ignored” within waiting list figures because England has different targets.
However, the BMA in Wales said it is not clear “if patients are counted on Welsh waiting lists either, due to having been referred to England”.
Delaying care for Welsh patients
Powys Teaching Health Board recently discussed asking hospitals in England to delay care given to Welsh patients, to save money without breaching Welsh waiting times.
The county does not have its own district general hospital and relies on those over the border.
Accessing patient records and referrals is also hindered by the different IT systems used.
The evidence included an example of a Wales-based senior consultant with experience of navigating the different health services.
Specialist services were not available in Wales, but to be treated over the border they needed an independent patient funding request (IPFR), which involved consultants in England writing to the health board in Wales.
“Due to inefficiencies in the system the individual has felt they had no choice but to pay for some of their treatment privately,” the evidence said.
“A non-medic or someone working outside the NHS would have struggled to navigate the system.”
In addition to specialist services, the BMA in Wales said latest figures suggest there are 13,300 Welsh residents registered with GPs in England, and 21,100 English residents registered with doctors in Wales.
Nearly 27,000 Welsh residents were on waiting lists for care in England in March last year – more than double the number recorded in 2011.
