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CCGs with high referral rates are ‘red-rated’

NHS managers have ‘red-rated' a series of clinical commissioning groups that have seen GP referrals soar past targeted levels, as GP practices brace themselves for a further clampdown.

A commissioning performance report for NHS South West London shows CCGs working across the cluster's five PCTs have seen referrals spiral beyond targets set in operating plans at the start of 2011/12.

In Kingston, where the Kingston Commissioning Committee took over responsibility for commissioning last May, GPs made 27,231 referrals between April and November – 5,626 more than the target of 21,695. CCGs in Richmond and Twickenham, Sutton and Merton, Croydon and Wandsworth were also behind target.

Dr Charles Alessi, chair of the National Association of Primary Care and a member of the Kingston Commissioning Committee, said the CCG was querying the figures, but added: ‘If there is a problem, we have to solve it by supporting primary care to manage conditions within their own practices.'

Exclusive: GPs have worked with a private company to dramatically cut the cost of patient care under a controversial scheme providing practices with incentives to deliver savings, Pulse can reveal.

Three clinical commissioning groups in Surrey, together with private consultancy firm Integrated Health Partners (IHP), have delivered savings of up to £20 per patient through wide-ranging efficiencies, including cuts in drug bills, referrals and hospital bed days.

IHP describes the venture as the UK's first managed-care organisation. It pays part of its fee for offering efficiency support to GPs as ‘rewards for good performance', and plans to develop a formal profit-share to split savings. It insists most savings are reinvested in patient care.

IHP has been working under contract for the three CCGs, but is about to finalise plans for a limited liability partnership with 10 GP practices covering 100,000 patients.

It has so far reviewed 50 care pathways and said the CCGs had reduced referral rates by an average of around 5% last year, and in one – Guildford and Waverley – bed days fell by 10%. It also found significant savings by cutting emergency admissions and the cost of elective procedures, and through ‘aggressive medicines management'.

Ratna Singh, corporate development director of IHP, said: ‘On profits, a small slice is shared with GPs as reward for good performance. Performance is measured on agreed criteria of clinical outcomes, patient satisfaction and financial performance.

‘Most surplus will go on re-investment – our frail elderly work has included extra nurses, geriatrician time, telehealth and 24/7 community support.'

The firm said in 2010/11 around £2 per patient was invested in Guildford and Waverley CCG, and it was on course to deliver a £3.7m surplus, equating to ‘more than £20 per patient'. The other two CCGs – Mid Surrey and East Elmbridge – were on course to underspend by 0.4% and 0.02% respectively, compared with an average overspend at other Surrey CCGs.

Dr Oliver Bernath, managing director of IHP, said savings had been achieved without restricting referrals, through discussions and education sessions, monthly practice visits, and GP guidelines on its website: ‘It's not rocket science – it's almost pedantic management of things. Our incentives are aligned with GPs. We figure out together how we do this and set internal targets by practice. It is not somebody else imposing upon them.'

Dr Tim Richardson, a GP in Epsom, Surrey, and former chair of Mid Surrey CCG, said IHP had delivered ‘quality and robust business intelligence': ‘What's been saved well outstrips what's been spent.'

But GPC negotiator Dr Chaand Nagpaul said GPs needed to be ‘very careful' not to compromise themselves in such deals: ‘It is vital GPs do not put themselves in a position where the public might question the motives of their commissioning decisions.'

Dr Louise Irvine, a GP in Lewisham, south-east London, said: ‘It is totally unacceptable that GPs should make money on commissioning savings.'

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