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GPs face postcode lottery over exception reporting

The new GMS contract is leading to a surge in referrals for cardiovascular disease, swamping secondary care services and leading to unnecessary interventions, consultants are warning.

Increases in referrals have emerged for stroke and angina as well as the problems with echocardiography revealed exclusively by Pulse last week.

The average practice can earn £525 for meeting referral indicators for angina and £150 for stroke.

Government advisers said referrals should be made on the basis of clinical need ­ and warned abuse of the system could lead to a range of sanctions including closure of practices.

Dr Vivian Challenor, consultant cardiologist at Cheltenham General Hospital, said: 'I've seen more of the sort of patients that would usually be sorted out by perfectly competent GPs ­ now I have to do it.'

Dr Challenor said the contract was judging GPs on 'artificial criteria' and described one incident where a GP had taken an angina patient off medication to confirm diagnosis, leading to needless referral.

And Dr Adrian Banning, consultant cardiologist at the John Radcliffe Hospital, Oxford, said GP referrals had risen in the run-up to the contract and included repeated investigations and confirmation of diagnoses. 'In the past people didn't feel the need to clarify it,' he said.

Stroke consultants said the jump in referrals was putting underfunded services under acute pressure.

Professor Martin Brown, consultant neurologist at the National Hospital for Neurology and Neurosurgery in London, said the increase had occurred in part because of the new contract.

He said: 'It's increasing the workload. There is no question more resources are needed for stroke services.'

Stroke services were 'stret-ched to the limit', the Stroke Association claimed.

Dr Ian Trimble, a Government adviser on the quality framework and a GP in Nottingham, said there was no evidence of abuse of the system yet, but practices that were found to be over-referring could be subject to sanctions including closure in the most extreme cases.

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