Nottinghamshire LMC wrote to practices this week to clarify their position on the new system being mandated by NHS England.
NHS England has asked CCGs to put systems in place to clinically peer review all GP referrals from this month.
Commissioning bosses have said the new requirement will help GPs support each other and ensure patients get the best care without unnecessary trips to hospital.
NHS England denied the scheme would mean referrals being vetoed by review panels.
GP leaders have criticised the plans, saying they risk undermining the relationship between GPs and their patients and senior GPs said the plans raise questions over patient safety.
In their letter to practices Nottinghamshire LMC chief executive Michael Wright and chair Dr Greg Place said: ‘We are concerned with how the implementation of this new requirement from NHS England has been handled, however well-intentioned it may be. There has been no consultation from NHS England with the GPC at national level and CCGs have been charged with rolling this out in their areas without any extra funding attached to it. We are aware of some areas of the country where CCGs have made the decision not to implement this, being aware as it is of the workload implications and lack of resource provided to support it.’
They added: ‘We are being asked whether this is mandatory for practices to engage with. Let us be clear that this is non-contractual work and that there is no obligation for practices to engage with it.’
The LMC leaders said that while there were sensible ways of looking at referral activity, ‘we feel that a national implementation that decrees that GPs inform the patient that they will be discussing the referral with a peer (something else we do not support), is not the answer’.
An NHS England spokesman said while CCGs were required to have a system of peer review in place, it was for them to decide how to implement it.
NHS England’s specification says: ‘CCGs are expected to work with their GPs to implement internal prospective clinical peer review for general practices by September 2017. CCGs may wish to consider prioritising the top 25% of high referring practices for initial roll-out and additional support.
‘It will apply to the majority of referrals. CCGs will need to define locally exceptions such as 2WW [two-week wait] cancer referrals, other urgent referrals, referrals going through an MSK triage (or other commissioned specialist triage) and those following receipt of advice and guidance from a hospital consultant etc.’