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GPs being paid to cut patient referrals GPs being paid to cut patient referrals
(about 1 hour later)
Some doctors in England are being offered thousands of pounds 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 being paid to help local NHS groups limit the number of patient referrals and cut 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 include scans and consultations with specialists - including those for cancer patients.Appointments affected include scans and consultations with specialists - including those for cancer patients.
The British Medical Association said such incentives were "misguided".The British Medical Association said such incentives were "misguided".
'Crude, salesman-like bonuses'
At least nine clinical commissioning groups (CCGs) 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 the equivalent of 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.
'Short-sighted'
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' Dr Peter Melton is local GP and clinical chief officer for North East Lincolnshire CCG, which offers the equivalent of 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.
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. He said the CCG was already among the best in England for referring suspected cancer patients to a consultant within two weeks and the scheme was not about avoiding sending people to hospital.
It is not clear how extensive the practice is across more than 200 clinical commissioning groups in England, he said. "It is not focussing on referral reduction per se but on better clinical and quality standards for the patient," he explained.
"The expectation is practices will be encouraged to investigate more locally and monitor the patient in the first instance rather than automatically refer in to a secondary care service."
Analysis by the BBC's Helen Briggs
The NHS is under pressure to make savings, with a target of carving out £22bn of efficiency savings by 2020.
NHS leaders want to cut patient referrals that are deemed inappropriate, particularly when patients could be cared for locally. There are more than 200 CCGs across England and, according to Pulse, at least nine are offering payment for keeping within targets for outpatient referrals and follow ups. It is not clear how extensive the practice is elsewhere.
Some have questioned the wisdom of the move, saying patients could miss out on vital care. But CCGs have defended their stance, saying it is about good practice, not about keeping people who need treatment out of hospital.
'Over-stretched'
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."
Dr Rosie Loftus of the charity Macmillan Cancer Support described the findings in Pulse as "very worrying". Dr Rosie Loftus of the charity Macmillan Cancer Support described the findings outlined in Pulse as "very worrying".
"This is yet another sign of an NHS which is seriously over stretched and not giving GPs the resources and support they need," she said."This is yet another sign of an NHS which is seriously over stretched and not giving GPs the resources and support they need," she said.
"England's cancer survival rates are already amongst the worst in Europe and a key reason for this is the inadequate access to cancer tests and treatment. " Are you a GP or a patient? What is your reaction to this? You can get in touch by emailing haveyoursay@bbc.co.uk
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