A doctor’s magazine, the Pulse, has found that NHS commissioning groups are offering financial incentives to GPs to cut patient referrals to hospital services. This is another in a long list of incentives to reduce demand for A&E, outpatient appointments and follow up services.
The investigation suggests that at least 9 clinical commissioning groups were offering to pay GPs for cutting the number of their patients being referred to hospital, both for emergency care and non-urgent diagnostic investigations, by 1%. This includes patients being referred under the two-cancer rule, designed to identify and treat cancers at the earliest opportunity. In one case, a surgery was paid £11,000 for meeting its reduced target.
Dr Chand Nagpaul, chair of the GP committee of the British Medical Association has said “it is 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…”.
This policy also flies directly in the face of the message sent out by NHS England no so long ago, a spokesman said “we explicitly want to increase not deter appropriate referrals for cancer checks”.
GPs are already seen as the gatekeepers of the NHS and they only refer patients for treatment when it is clinically indicated. A GP would be considered to be incompetent if they were routinely referring patients when unnecessary. This practice is doing one of two things, it’s either an open accusation that GPs are not following their professional and ethical code and that referrals figures can actually be cut without risking patient health, which is highly unlikely, or it is asking GP’s to put patients health at risk by arbitrarily denying a patient a referral. Essentially creating a health lottery, with the winning balls being drawn in the consulting room.
This not only presents a risk that patients requiring treatment will either have it denied or delayed, but it puts GPs in an unacceptable and unfair position of having to risk their patient’s health in return for meeting targets and obtaining funding which, like all health services, is desperately needed.
GPs could find themselves practising negligently if they routinely defer hospital referrals in order to meet targets. Increasing numbers of patients will become dissatisfied with the level of service offered which could lead them to complain or even make a claim against the surgery when otherwise they would not have done so. GPs will have to justify their decisions not to refer patients where it is suspected one should be made and lawyers may even force them to disclose details of payments they have received for meeting reduced targets.
GPs and the BMA must resist pressure from CCGs to reduce referrals on anything other than a purely clinical basis and concentrate on what they do best, safeguarding their patients health and obtaining the right care at the right time. They must not let their professional integrity and good practice be impaired by budgets and problems faced by other NHS organisations.
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