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Independents' Day

GP practices offered funding to cut cancer referrals in new scheme

A CCG is offering practices incentives to cut all referrals – including cancer referrals – Pulse has learnt.

Pulse’s ‘Cash for cuts’ investigation has found that NHS Rotherham CCG’s ‘quality contract’ scheme incentivises practices to cut referrals by 1% or come down to the CCG average.

However, unlike other schemes uncovered by Pulse, the scheme includes cancer referrals.

Under the quality contract, practices are expected to ‘reflect on current referral behaviour’, including peer review – especially of locums – in a scheme worth £3.36 per patient.

A third of this funding is awarded for meeting the target to cut referrals.

When asked whether this included cancer referrals, a spokesperson said: ‘The quality contract encourages appropriate clinical management of referrals and no referrals are excluded from our data.’

The Rotherham scheme also involves senior GPs being incentivised to check referrals from locums.

In 2015, Pulse revealed that two CCGs – NHS Lambeth CCG and NHS North East Lincolnshire CCG – had implemented incentives schemes that rewarded GPs for cutting cancer referrals.

Under the schemes, NHS Lambeth CCG offered payments for practices moving towards the average 2014/15 CCG referral rate per 1,000 patients while NHS North East Lincolnshire CCG had offered payments that would equate to more than £6k for the average practice to reduce outpatient referrals to the same level as the 25% of practices with the lowest referral rates – including two-week urgent cancer referrals – in 2014/15.

At the time, Dr Robert Morley, chair of the BMA GP Committee’s contracts and regulations subcommittee, said these two schemes were ‘extremely concerning’, adding: ‘These may, at face value, potentially be ethically questionable and conflict with GMC guidance, on the basis that they might conceivably influence individual management decisions.’

But in a recent freedom of information response, NHS North East Lincolnshire CCG confirmed they no longer have any referral incentive scheme in place, while NHS Lambeth CCG said they currently have no target in place for a reduction in referrals.

Readers' comments (9)

  • NO NO this wont be in the MAIL.

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  • Once you have dealt with your first complaint after a delayed referral, you won't let it happen again.

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  • Come on Pulse and everyone commenting on all these similar themed articles. We all know that there is variation in the quality and variation of referrals by colleagues. Most of these CCG schemes are an attempt to understand that variation and ask practices to reflect on their thresholds and effective use of commissioned pathways. Our patients do not want to be referred into specialist pathways of care when that is unlikely to change the outcome of the problem they present with. They also expect us to make effective use of what we all know are limited NHS resources, which is after all what British general practice has been renowned for in the past. I would agree with the RCGP's (and BMA's to be fair) distinction between supporting high quality referrals and not managing them however, but this distinction can be rather nuanced. I accept that increasing risk averseness, the interpretation of guidelines and general uncertainty are making this gate keeping role more difficult. Do we want to abandon that role? I sense some GP colleagues do but it has been, like it or not, what most defines our role in our health economy.

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  • @ Vortexman - Everyone can agree that reflection on the referral process is useful and that this especially so for outliers.

    For heavens sake though can we just stop providing bullets for our critics by even suggesting rewarding non-referral financially. How many more DM headlines will it take?

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  • Thanks @Midlands Doc. The problem is that CCG's would really like their member practices to participate in this reflection and accept support naturally but that has probably proven difficult in some areas without them being asked to somehow incentivise that. I share the profound distaste for any direct relationship between referral avoidance and a payment. That said we do need to accept some concept of indicative budgets if we are achieve the real left shift of resources many argue for.

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  • Macaque

    This sounds like 'Magdalenism'. LOL

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  • CCGs and referral management leads consistently ignore key quality indicator for referrals- conversion rate from 1st referral to a diagnosis or hospital treatment. Incentive for improving conversion rates, access to high quality ‘map of medicine’ and inter-practice referral group to include mapping of GP based expertise are areas we have used to improve quality of referrals in BIRMINGHAM. It has worked very well and besides achieving high conversion rate, we had lowest referral rate and lowest emergency attendances and admission in the region.
    In summary - incentivise for quality indicators and not as hoc quantity parameters.

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  • I think CCGs and NHSE elite would happily cut all referral in deprived areas just to make the funding more manageable for richer areas. Do the terms morality and ethics actually exist for these blithering fanatics whose whole aim is to get the numbers right by hook or crook?

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  • Peter Patel for President!

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