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Independents' Day

GPs to be offered 'shared savings' from cutting A&E attendance

GPs working within primary care networks will be able to take part in a ‘shared savings’ scheme that will allow them to ‘benefit’ from efforts to reduce avoidable A&E attendances, admissions and delayed discharge.

The new scheme was announced today in the NHS’s long-term plan, which also sets out plans to see GP practices join primary care networks.

According to GP leaders, all practices in England will be contractually required to join networks serving 30-50,000 patients from April.

Today’s NHS long-term plan states: ‘We will also offer primary care networks a new “shared savings” scheme so that they can benefit from actions to reduce avoidable A&E attendances, admissions and delayed discharge, streamlining patient pathways to reduce avoidable outpatient visits and overmedication through pharmacist review.’

But GPs have warned against the new scheme if it means practices are provided with direct payments for cutting the number of patients going to hospital.

Family Doctor Association chair Dr Peter Swinyard said: 'If you are going to say to the GP "I am going to pay you to avoid referring patients to hospital", that is not acceptable.'

Dr Swinyard also questioned how far GPs could reduce avoidable A&E attendances, adding that more needed to be done to improve awareness among patients about the availability of urgent GP appointments.

He said: 'I genuinely don't know what I could do that makes it less likely people will rock up to casualty. 

'Clearly accessibility is one of the biggest things. Although in many practices we may have a three-week wait for non-urgent consultations, the overwhelming majority of practices will see urgent patients on the day. I think this is something patients are not totally aware of.

'I think they ring up and are told it's three weeks for an appointment, so they hang up and go to casualty.'

Dr Richard Vautrey, BMA GP committee chair, said it was hoped the new 'shared savings' scheme would enable more money to be reinvested into community services.

'GPs and their teams have an important role to play in ensuring that where care can and should be provided in the community, it’s done with the patient’s best interests at heart, avoiding unnecessary hospital referrals and long waits for treatment.

'Of course, GPs will always use their clinical judgement to decide when it is necessary to refer a patient on to secondary care. NHS England’s proposals will formalise arrangements that are already in place in many areas and, we hope, will enable practices to reinvest funding into improving community services and by doing so make them sustainable.'

In the past, GP leaders have criticised schemes that provide financial incentives for cutting patient referrals to hospitals.

Last year a major Pulse investigation revealed around a quarter of CCGs in England offered some kind of financial inducement for reducing referrals to specialists.

In five regions, GP practices were being offered controversial ‘profit share’ agreements that meant they were paid up to half the savings if they refrained from referring their patients to hospital.

GPs at the time said the schemes represented a ‘serious dereliction of duty, influenced by CCGs trying to balance their books’.

Despite the concerns, Pulse later reported in the autumn that three of the profit-sharing schemes had been taken forward to the 2018/19 financial year, and one was under review.

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Readers' comments (9)

  • It is not going to work as it is morally wrong and goes against what being a doctor is all about.The system is fundamentally broken.
    If it has to go to A+E it has to go. We do not refer unnecessarily.
    Just remember Gross Negligence Manslaughter charges if one does not refer when needed.

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  • GPs are gatekeepers, the whole point is to stop people needlessly going to hospital, if we become conduits to hospital then why should a system pay for a middleman. Rewarding practices for cutting referrals / A&E attendances is a great idea -- where it's been tried before it has worked well.

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  • Actually GPs are not the primary reason for people rocking up at A&E.

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  • Thanks for the blood money. I'd rather have a clean conscience.

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  • doctordog.

    Completely unethical.

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  • Most people who don't need to go to A&E but do go themselves, usually for convenience and their own exception and need.easy pollution HMG get rid of the waiting target have unnecessary attendee be triaged into a when convenient stream have a target for this one at 12 hrs.They will not stay.

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  • A&E is in the name accidents and emergencies.

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  • I can see the daily moan article: "Greedy GP paid blood money not to send a young single mother on benefits that has died to A+E slapped with Manslaughter Charges (equivalent to stabbing someone intentionally).NHS denies all responsibility saying it is the doctor's clinical decision".

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  • We have lots of ideas to make an impact but it means putting clinical capacity to work where we need and not where DoH feels it'll get a political premium!

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