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Government closes loopholes to stop 'fundholding' windfalls

GPs have condemned 'invasive' and 'threatening' efforts by primary care organisations to scrutinise outpatient referral rates and target high-referring practices.

The criticism came as doctors predicted a surge in PCO monitoring of GP referrals to cut 'unwarranted' activity in the run-up to April 2005.

But GPs warned the checks were overly-simplistic and failed to take account of factors such as deprivation.

The row was sparked after Southwark PCT revealed plans for a practice-based commissioning scheme involving incentives for GPs who could beat referral targets in areas such as dermatology, endo-crinology, neurology and ENT.

Croydon PCT has also announced targets to encourage 'high-quality' referrals after identifying that some practices referred one-sixth the number of patients as others.

GPs raised concerns that such targets would be based on quantity alone and trusts would be unable to define a 'good' or 'bad' referrer.

Dr Michael Brooks, a member of Southwark LMC, said: 'A GP may refer far more patients than a colleague ­ that could be a lack of confidence, but it could be that the doctor is doing an excellent job.'

Mabli Jones, deputy-director of modernisation at Southwark PCT, said it would take into account 'factors where you would expect to see differences'.

Dr George Rae, secretary of Newcastle and North Tyneside LMC, said it was inevitable referrals would be scrutinised and many doctors would be alarmed.

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