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GPs being paid to cut patient referrals GPs being paid to cut patient referrals
(about 3 hours later)
Doctors are being offered thousands of pounds in bonuses to cut the number of patients being sent to hospital, an investigation has found. Some doctors in England are being offered thousands of pounds to cut the number of patients being sent to hospital, an investigation has found.
GP practices are incentivised to help local NHS groups limit the number of patient referrals, cutting costs, the doctors' magazine Pulse found. GP practices are being paid to help local NHS groups limit the number of patient referrals and cut costs, the doctors' magazine Pulse found.
Appointments affected included scans and consultations with specialists. Appointments affected include scans and consultations with specialists - including those for cancer patients.
The British Medical Association GPs committee said such incentives were "crude" and "misguided". The British Medical Association said such incentives were "misguided".
'Crude, salesman-like bonuses''Crude, salesman-like bonuses'
At least nine clinical commissioning groups (CCGs) in England were offering GP practices payments for hitting targets, according to Pulse's investigation. At least nine clinical commissioning groups (CCGs) were offering GP practices payments for hitting targets, according to Pulse's investigation.
In one case a CCG was offering practices more than £11,000 to reduce new outpatient attendances, follow-ups, A&E attendances and emergency admissions by 1%, compared with 2014/15.In one case a CCG was offering practices more than £11,000 to reduce new outpatient attendances, follow-ups, A&E attendances and emergency admissions by 1%, compared with 2014/15.
Another CCG offered more than £6,000 to practices that reduce outpatient referrals to the same level as the 25% with the lowest referral rates - which include two-week urgent cancer referrals - in 2014/15.Another CCG offered more than £6,000 to practices that reduce outpatient referrals to the same level as the 25% with the lowest referral rates - which include two-week urgent cancer referrals - in 2014/15.
One CCG told Pulse it had considered the "full impact" of the incentive scheme and was "confident that there is no conflict of interest".One CCG told Pulse it had considered the "full impact" of the incentive scheme and was "confident that there is no conflict of interest".
Another said urgent care and two-week cancer referrals "cannot be separated" from its referral targets.Another said urgent care and two-week cancer referrals "cannot be separated" from its referral targets.
Pulse said that one scheme had already been looked at by the General Medical Council, the body which regulates medical standards in the UK, after local GP leaders expressed their concern.Pulse said that one scheme had already been looked at by the General Medical Council, the body which regulates medical standards in the UK, after local GP leaders expressed their concern.
The magazine pointed out that initial hospital referrals for cancer patients should happen within two weeks of a GP first suspecting the condition.The magazine pointed out that initial hospital referrals for cancer patients should happen within two weeks of a GP first suspecting the condition.
Dr Chand Nagpaul, chairman of the GPs committee of the doctors' trade union the British Medical Association, told BBC Radio 4's Today programme that such schemes were a "financial contaminant" to patient-doctor trust.Dr Chand Nagpaul, chairman of the GPs committee of the doctors' trade union the British Medical Association, told BBC Radio 4's Today programme that such schemes were a "financial contaminant" to patient-doctor trust.
He said: "It's short-sighted and misguided of CCGs to introduce such mechanisms, because they do lead to the potential for patients questioning the motives of GP referrals.He said: "It's short-sighted and misguided of CCGs to introduce such mechanisms, because they do lead to the potential for patients questioning the motives of GP referrals.
"We believe it is far more appropriate for CCGs to introduce clinical pathways that ensure patients are referred appropriately rather than these crude, salesman-like bonuses which pay GPs simply to make reduction to referrals in numerical terms.""We believe it is far more appropriate for CCGs to introduce clinical pathways that ensure patients are referred appropriately rather than these crude, salesman-like bonuses which pay GPs simply to make reduction to referrals in numerical terms."
'Increase not deter''Increase not deter'
The BBC's health correspondent, Adam Brimelow, said NHS leaders wanted to cut patient referrals that were deemed "wasteful" or "unnecessary" - particularly when patients could be cared for at their local GP surgeries.The BBC's health correspondent, Adam Brimelow, said NHS leaders wanted to cut patient referrals that were deemed "wasteful" or "unnecessary" - particularly when patients could be cared for at their local GP surgeries.
But he said financial schemes to achieve this were controversial.But he said financial schemes to achieve this were controversial.
It is not clear how extensive the practice is across more than 200 clinical commissioning groups in England, he said.It is not clear how extensive the practice is across more than 200 clinical commissioning groups in England, he said.
In November the NHS advisory board said GPs in England should nearly double the number of patients referred to hospital for cancer tests.In November the NHS advisory board said GPs in England should nearly double the number of patients referred to hospital for cancer tests.
The National Institute for Health and Care Excellence said delays in spotting symptoms could be costing thousands of lives each year.The National Institute for Health and Care Excellence said delays in spotting symptoms could be costing thousands of lives each year.
NHS England said: "We explicitly want to increase not deter appropriate referrals for cancer checks."NHS England said: "We explicitly want to increase not deter appropriate referrals for cancer checks."