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GPs who over-refer face penalties on quality pay

By Cato Pedder

NHS managers will have the right to dock practices' quality pay if they suspect GPs have been over-referring patients in a bid to hit quality targets.

PCTs have been given

powers to 'rescore' practices if there is any evidence of GPs 'inappropriately referring patients to maximise quality achievement points'.

Diabetes, COPD and ep-ilepsy have been flagged up by trusts as the most likely areas of contention where GPs could claim pay for work done by specialists to achieve disease control targets.

But GP Government advisers have attacked the powers ­ buried in Government guidance on the new contract ­ as 'silly' and 'unnecessary'.

The NHS Confederation made it clear that trusts would have carte blanche to decide what constitutes 'inappropriate' referral. But a spokesman stressed the LMC would be consulted in any suspected case and GPs would have the right to appeal.

George McIntyre, chief executive of South Leeds PCT ­ who has spoken on the issue at NHS Modernisation Agency workshops ­ admitted it would be 'extremely rare' for GPs to systematically defraud the NHS. But he predicted PCTs would step up their scrutiny of referral rates to detect any attempt to earn quality points by over-referring.

'I am not suggesting we should arrive like Special Branch,' he said. 'I have been advising PCTs to work with practices, rather than go through punitive financial discussions.'

Dr Paul Zollinger-Read, a GP in Braintree, Essex, and a Government adviser on GP referrals, said: 'This is silly.' It was 'very difficult' to define inappropriate referral, he said.

'It will be entirely subjective.'

Dr Ian Trimble, a GP in Nottingham and Government adviser on the quality framework, said: 'In theory GPs could flood hospital clinics ­ but I don't think it will happen. Not all GPs are money grabbing and some actually do want to provide high-quality care for patients.'

GPC joint-deputy chair Dr Simon Fradd said it would be difficult for GPs to abuse referrals to earn quality points: 'Most fiddles probably cause you more work.'

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