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A faulty production line

High referral rate may be a good thing

If NHS Primary Care Commissioning fondly imagines punishing GPs for their patients' recurrent attendances at A&E will ‘weed out' poorly performing GPs, it is clearly staffed by short-sighted idiots.

PCTs to launch renewed blitz on 'dysfunctional' GP practices

High A&E attendance might reflect appropriate attendances for, for example, chest pain in patients with ischaemic heart disease in areas with high prevalence. If a ‘poorly performing' GP was handed a red card and noticed there was a large number of A&E visits by the Miggins family in a given period they might be tempted simply to remove the Migginses from the practice list to improve its figures.

If this situation was repeated among other practices they subsequently registered with, it would result in the family being unable to register locally and even more likely to attend A&E, worsening the problem. But of course, this would be their GP's fault...

Dr Merlin Dunlop

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