This site is intended for health professionals only

At the heart of general practice since 1960

pulse june2020 80x101px
Read the latest issue online

The waiting game

GP practices offered ‘ethically questionable’ incentives to cut urgent cancer referrals

Exclusive GP practices are being offered thousands of pounds to refer fewer patients for specialist care, including those with suspected cancer, finds a Pulse investigation.

Pulse has learnt that in at least nine CCGs, practices are being offered payment for keeping within targets for outpatient referrals and follow-ups. And some of these schemes even count two-week cancer wait referrals towards the target.

The GPC says many of these schemes could be ‘ethically questionable’ and Pulse has learned that the GMC looked into at least one of them to see if it is contrary to the guidance for doctors in Good Medical Practice.

The investigation comes as the health service prepares to implement £22bn of efficiency savings by 2020, and shows that restrictions are increasing on routine, front-line care. Examples of the schemes that are being run across the country are:

  • NHS North-East Lincolnshire CCG is offering 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.
  • NHS Birmingham South Central CCG is offering the average practice a payment that would equate to in excess of £11k to reduce new outpatient attendances, follow-ups, A&E attendances and emergency admissions by 1%, compared with 2014/15. The CCG says it has considered the ‘full impact’ of the incentive scheme and is ‘confident that there is no conflict of interest’.
  • NHS Lambeth CCG is offering payments for practices moving towards the average 2014/15 CCG referral rate per 1,000 patients. The CCG claims that urgent care and two-week cancer referrals ‘cannot be separated’ from the overall numbers.

Dr Robert Morley, chair of the GPC’s contracts and regulations subcommittee, told Pulse that schemes incentivising practices to reduce urgent cancer referrals were ‘extremely concerning’.

He added: ‘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.’

Former RCGP chair and Lambeth GP Professor Clare Gerada told Pulse she believes such schemes risk ‘interfering with the doctor-patient relationship.’ She says: ‘Once we start incentivising to reduce activity, then it puts a conflict within the consulting room.’

Pulse has learnt that one scheme has already been looked at by the GMC, after being referred by local GP leaders.

Dr George Ogden, chair of Bolton LMC, told Pulse that the LMC fears that NHS Bolton CCG’s ‘quality contract’, which pays practices for reducing referrals for procedures of ‘limited clinical value’ by 20% – such as vasectomies – and for reducing first outpatient appointments and follow-ups by 1%, could fall foul of the GMC’s guidance.

Dr Ogden said: ‘The GMC said it would potentially be regarded as an inducement if there was a challenge that GP behaviour changed as a result of the payment. So they were concerned, but didn’t say it was entirely against the guidance.’

A moral dilemma: GP practices offered incentives to cut urgent referrals

‘The scheme presents us with a conflict of interest’

Readers' comments (41)

  • These schemes are immoral. It would be better to admit the NHS blocks good care and campaign for top ups or leaving the NHS.

    Unsuitable or offensive? Report this comment

  • "Once we start incentivising to reduce activity, then it puts a conflict within the consulting room"

    Why would this be any different from incentivising to increase activity (eg statin prescribing)?

    I'm not saying that both incentives are fine, just that both are equally ethically questionable and I can't see any reason to accept one and reject the other.

    Unsuitable or offensive? Report this comment

  • If this is happening, it is criminal behaviour. Thank goodness, we in Medway don't have that pressure though the government drive to cut 'Unplanned admissions' has been accepted by most Practices at least partly due to incentives - without wishing to ruffle a few feathers.Personally, it's no go zone for my Practice.

    Unsuitable or offensive? Report this comment

  • Will the 'incentive' payment cover the extra cost of indemnity cover when cases are missed?

    Unsuitable or offensive? Report this comment

  • Bravo!! You are damned if you do and damned if you don't !

    Unsuitable or offensive? Report this comment

  • It's really interesting that as soon as money is brought into any equation within the NHS, people are up in arms about conflicts of interest. What about private health care? Many consultants participate in it - we just expect them to use their training, clinical skills and integrity to treat patients according to need and not personal gain. Why do people thing GPs are unable to do this?

    If there is an incentive which makes you pause, discuss a referral with a colleague and think of alternative pathways, what's wrong with that? If the cash incentive stops you making a referral which you should be making, you should be seriously questioning your integrity.

    Unsuitable or offensive? Report this comment

  • Totally unethicial . Interfers with Doctor/Patient relationship. I have doscussed with GMC MDU and they say duty of care is to the patient.
    One of the reasons I have resigned from being a GP

    Unsuitable or offensive? Report this comment

  • If we wish more care to happen in a community setting, then the resources have to follow. Isn't that the simple answer?

    Unsuitable or offensive? Report this comment

  • disgusting. unethical. immoral.

    i will continue to refer any and all patients that are appropriate and screw targets.

    Unsuitable or offensive? Report this comment

  • Please pass this on to the media.

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page50 results per page

Have your say