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Financial incentives and client care – Could your GP be receiving a bonus NOT to refer you to hospital?

GP practises across the country are receiving thousands of pounds not to refer patients to hospital for specialist treatment, according to a recently published report by Pulse magazine.

These ethically questionable ‘referral management schemes,’ are giving GP’s a financial incentive to cut down the number of referrals they make to specialist care and pushing them to meet tight referral targets. For many the most controversial finding of the report was that many practises included first appointments for cancer – that should occur within two weeks of a GP suspecting the disease – in their targets to cut referrals.

The rewards are being offered by clinical commissioning groups (CCGs), the NHS bodies responsible for the planning and commissioning of healthcare in their local area. These groups have cited the schemes as a way to cut down on unnecessary referrals and are a bid to have more patients being treated by physiotherapists, community nurses and non-specialist staff. Helen Clanchy, director of primary care for Hampshire PCT, said: “The scheme is about getting GPs to understand they have got a number of alternatives to referral. Primary care has many experienced doctors, trained to consultant level, who are in a position to spot symptoms that need referral or immediate hospitalisation.”

However, it has to be questioned how appropriate it is to offer financial incentives when dealing with client care of this nature. There is a genuine fear GPs will face unfair pressure not to make referrals, against their clinical judgement, because of these strict referral targets.

Health chiefs have defended the payments, saying they are a way of encouraging GPs to spend a bit longer weighing up the pros and cons of referring patients. It is clear every patient deserves their case fully discussed, alternatives to hospital referrals considered and ultimately the most appropriate action taken. Nevertheless, we should be safe in the knowledge this is happening regardless of any promise for financial gain. Setting targets that are linked to financial incentives undermines the trust placed in GPs by their patients; the prospect of pocketing a bonus should not have to be weighed up by any health professional when making a decision on clinical care. Dr Alistair Moulds, a GP from Laindon, Essex, who refused to sign up to a South Essex scheme said “Paying GPs to try to keep patients, especially emergency admissions, out of hospital could be dangerous to patient care and safety. I don’t think most GPs would not send someone to hospital in order to make fifty pounds, but I don’t think that financial incentive should be there at the point a doctor is making a critical decision.”

This is a worrying illustration the NHS buckling under the pressures of Government plans to make £22 billion worth of efficiency savings by 2020. No doubt it is critically important to make referrals as efficient and effective as possible but every decision by a non-specialist not to refer a patient should be taken extremely seriously. These targets may artificially reduce the amount of people referred to specialist care while the real issues which lead to these referrals continue to go unaddressed.

As an individual you should be safe in the belief that your GP will always be acting in your best interest and not have to question whether the prospect of a large bonus had any effect on your care plan. These schemes not only seriously jeopardise patient trust but put patients at real risk of life threatening conditions going unrecognised.