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At the heart of general practice since 1960

Hep B 'penny-pinching'

Consultants are demanding a share of GPs' quality pay because of a huge increase in the number of referrals since the new contract.

Hospital doctors said they were being stopped from carrying out specialist work because GPs were referring more patients for diagnoses and tests that could be be done in primary care.

The claim comes after primary care organisations revealed plans to use a clause in the contract allowing them to dock quality pay from GPs found to be over-referring in order to hit targets. But GPs said the consultants' claims on their quality pay were 'laughable' and they should turn away referrals if they were inappropriate.

Dr Dinesh Mistry, consultant in cardiology at the Royal Shrewsbury Hospital, said the contract gave practices 'esoteric' reasons to refer patients, even if they did not need any tests carried out. He said many elderly patients with longstanding chronic conditions had been referred just to confirm diagnosis.

'I get 90-year-old patients who are completely independent suddenly referred for exercise testing and echoes,' he said. 'Echoes and patient reviews should be done in primary care. GPs are not making a reasonable assessment of whether they should be referring patients to a specialist.'

He said consultant colleagues in diabetes and hypertension had also seen an increase in workload. 'The hospital should get remuneration for that,' Dr Mistry added.

Another cardiologist in the West Midlands, who asked not to be named, said GPs had to be 'more selective' in referrals. He said: 'We need to see resources matching workload.'

But Dr Bob Morley, a GP in Birmingham, said it was 'laughable' to think GPs would refer to secondary care for chronic disease management and dismissed consultants' claims on their quality pay.

He said: 'The quality of chronic disease management in primary care may be variable but there's nothing variable about it in secondary care ­ it's universally appalling.'

GPC deputy-chair Dr Laurence Buckman said he would 'question the wisdom' of a consultant who did not turn inappropriate referrals away.

By Ian Cameron

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