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Drive to curb emergency GP referrals

Ministers are poised to pile the pressure on GPs over emergency referrals with a tough target to cut 'inappropriate' hospital admissions for chronic diseases by 15 per cent.

Department of Health officials will this week hammer out details of the new NHS-wide target – which will intensify PCT scrutiny of individual practices' referral rates.

The GPC reacted with fury to the proposal and the Government's own emergency care tsar urged ministers to think 'very, very carefully' before resorting to the target.

The plan emerged as a new report from the department reached a damning verdict on standards of GP care for the chronically ill. It concluded: 'Routine day-to-day care of chronic diseases is not good enough – patients are dev-eloping unnecessary complications and dying prematurely.'

The report highlighted substandard care of diabetes, heart failure, asthma and COPD, claiming improved management could cut emergency admissions and ease the burden on NHS resources.

The emergency referrals target is one of just six new public service agreements being thrashed out between the department and the Treasury.

It is expected to come into effect this summer as part of the Chancellor's three-year spending review. Health Secretary John Reid will take personal responsibility for ensuring the target is met.

The move has been prompted by Mr Reid's determination to force the NHS to embrace a US-style revolution of chronic disease management. Officials see the emergency admissions target as a key tool to drag PCTs on board.

The department's head of primary care, Gary Belfield, told a recent chronic disease management conference: 'If people go into hospital it's a failure of our system.'

He insisted PCTs had enough money to transform chronic disease care by funding an immediate roll-out of the active case management approach pioneered by the US Evercare scheme.

GPC negotiator Dr Laurence Buckman was adamant targets were not the way forward. He said: 'If this goes ahead we will be very distressed. People who go to hospital are usually admitted because they are sick.'

Emergency care tsar Professor Sir George Alberti was also sceptical, saying: 'It is very

difficult to arrive at a suitable target.

'Measuring what is inappropriate is difficult. This needs to be very, very carefully thought out.'

lFlawed evidence, page 7

By Alisdair Stirling and Emma Wilkinson

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