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‘Questionable’ incentives slammed by lead GPs

Fees to cut patient referrals ‘misguided’ says BMA

Jo Carlowe

Friday, 02 October 2015

Schemes by which GPs are paid incentives to cut patient referrals, have been widely criticised by leading doctors. 

According to Pulse magazine, several clinical commissioning groups (CCGS) were offering GP practices “ethically questionable” incentives to cut referrals. In some cases, practices were offered thousands of pounds to refer fewer patients for specialist care, including those with suspected cancer. 

Pulse reported that at least nine CCGs were offering payments of this sort, including NHS North-East Lincolnshire which offered payments equating to more than £6,000 for the average practice to reduce outpatient referrals to the same level as the 25% of practices with the lowest referral rates in 2014/15. Likewise, NHS Birmingham South Central CCG offered the average practice a payment in excess of £11,000 to reduce new outpatient attendances, follow-ups, A&E attendances and emergency admissions by 1%, compared with 2014/15.

The British Medical Association has spoken out to describe such incentives as “misguided”. 

Speaking this morning on BBC Radio 4’s Today programme, Dr Chand Nagpaul, chairman of the BMA’s GPs committee, said such schemes were “a financial contaminant” to patient-doctor trust. 

Commenting to OnMedica, Dr Richard Vautrey, deputy chair of the BMA’s GP Committee, said: “We have always opposed schemes that set targets for GPs not to refer patients as there is a risk they could undermine patients confidence that GPs will always do the right thing for them. There is also the potential risk that patients don't get the right specialist care that they need as a result. If practices are presented with such schemes by their CCG they should work with their LMC to resist and redesign them.”

The General Medical Council has confirmed that at least one CCG has approached the GMC for advice on the use of incentive schemes. 

Niall Dickson, Chief Executive of the GMC, said: “Any doctor taking part in such a scheme should carefully consider our guidance, Financial and commercial arrangements and conflicts of interest, when they make recommendations for treatment or referral.

“Finance and other incentives can be an effective way of driving improvements in healthcare, for example, where the goal is to encourage better use of limited resources and up-to-date clinical guidelines. But of course doctors need to satisfy themselves that the scheme will benefit their patients and that there is flexibility to meet the needs of individuals. If a doctor does have concerns about a scheme, they should raise their concerns through the appropriate local and national channels.”

Dr Maureen Baker, Chair of the RCGP, has also criticised the use of incentives to GP not to refer patients to hospital. She said: "This is a preposterous idea. It is deeply insulting and demeaning - as well as being highly unethical - to suggest that offering GPs money will change the way in which we care for our patients.

"Most worryingly, it undermines the doctor patient relationship and the trust that underpins it.

"GPs are highly trained and highly skilled medical professionals who will always make decisions in the best interests of our patients based on their clinical needs.”

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