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Audit clears GPs of blame over emergency referrals

By Cato Pedder

GPs are cleared of blame for their part in a high-profile controversy by an audit that suggests rising emergency referral rates may be beyond their control.

The audit ­ covering a PCT that tried to offer GPs financial incentives to cut emergency referrals ­ revealed deprivation could explain 50 per cent of the dramatic variation in practice rates.

GPs' emergency referrals have been under scrutiny since 2000 when the Prime Minister accused GPs of 'misusing' them to jump waiting lists.

The joint annual public health report of South Worcester, Redditch and Bromsgrove and Wyre Forest PCTs said local rates had been rising by 3 per cent a year for the past four years but suggested several factors could explain variation between the 68 practices in the area.

These included deprivation, patients' age, increasing demand, increased bed availability and proximity to A&E.

GPC prescribing chair Dr Peter Fellows said there were 'a thousand and one' reasons for GPs to make emergency referrals.

'The fact is GPs need more time and less pressure to reduce referrals,' he said.

Dr Simon Parkinson, Wor-cestershire LMC secretary and a GP in Redditch, Worcestershire, said all GPs should be reviewing their emergency referrals already as a matter of good practice.

But only a small proportion of emergency admissions came through GPs in their practices with many resulting from self-referral. 'It is totally out of GPs' control,' he added.

Dr Ian Trimble, a Government adviser on general practice and a GP in Nottingham, said most PCTs were examining GP emergency referral rates but warned deprivation-adjusted rates should only be used for 'simple bench-marking'.

Last September, South Worcester PCT was forced to abandon plans to pay GPs rewards for cutting referrals after the GPC condemned the scheme as 'immoral'.

Dr Tim Davies, director of public health at South Worcestershire PCT, said: 'Our report suggests an amount of variation is due to deprivation and other factors. But that wouldn't mitigate against encouraging GPs to only refer when it is appropriate.'

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