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GPs to be paid to cut referral rates

By Gareth Iacobucci

PCTs are spending millions to try to persuade GPs to bring down their referral rates in the wake of an unexplained leap in hospital activity.

Trusts are introducing a series of practice-based commissioning incentive schemes to tackle the 16% rise in GP referrals, which threatens to land them with major deficits.

But the moves have prompted concerns that GPs may be rewarded for taking the wrong medical decisions and asked to save money rather than offer the best treatment.

Details of a series of PBC schemes emerged as a new study warned that attempts to clamp down on practices' admission rates were often inappropriate (see below).

Oxfordshire PCT is offering GPs in the area up to £1.2m in incentive payments if they can successfully reduce the number of referrals to local hospitals.

Oxford and Radcliffe Hospitals NHS Trust faces an annual overspend of £22m and the PCT a year to date overspend of £2m, following a surge in GP referrals.

The PCT is spending some of the money paying GPs to take time out of surgery to discuss ways of adjusting their behaviour, and says there are some signs the measures are beginning to work.

Alan Webb, PCT director of commissioning, said: ‘What we are trying to do is understand what is driving the increase in referrals.

‘This additional incentive scheme is asking GPs to review referral activity and processes with colleagues, which will take time. We are not paying them not to refer.'

Dr Lisa Silver, a GP in Nettlebed, Oxfordshire, said the reasons for the jump in referrals were complex, but welcomed the incentive scheme.

‘I don't have a problem that we are being incentivised to look at our referral activity. We can't ignore it. If we do, services will need to be cut in order to address that deficit.'

Elsewhere, Brent PCT is telling practices they must submit plans ‘which detail how they will achieve demand management targets' in order to receive payments.

And in Essex, the trust has set up a target-driven incentive scheme under PBC including cuts to local outpatient referrals, outpatients follow-up, A&E Attendances and emergency admissions.

Dr Alistair Moulds, a GP in Laindon, Essex, said his practice had refused to sign up to the scheme because of the dangers of inappropriately butting pressure on GPs.

‘We've decided not to sign up for it, because we don't think it's very sensible or feasible,' Dr Moulds said.

Dr Johnny Marshall, new chair of the National Association of Primary Care, said: ‘Any incentive scheme should be looking to drive up the quality of local services. Just cutting the numbers of referrals without putting in the service re-design can lead to poorer service delivery.'

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