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GP practices offered top-up funding for cutting referrals and prescriptions

Exclusive GPs are being promised extra money for cutting secondary care referral rates to 'below the average' in their area, in the latest 'cash for cuts' scheme to be unveiled by Pulse.

GPs in south London have been invited to receive incentives if they meet a list of 22 performance targets, including reducing non-cancer referrals, reducing requests for pathology testing, cutting over-the-counter prescribing and increasing flu vaccine uptake.

Pulse understands that the list of targets was devised as part of wider savings initiatives by NHS Lewisham CCG, which has been tasked with shaving £20m from its annual budget.

Although the CCG would not disclose the financial value of the scheme to practices, claiming this was 'commercially sensitive', it said incentives would be based on practice list size - with referral cuts amounting to 10% of the potential additional funding available.

The news comes as Pulse has previously unveiled major concerns over new incentive schemes to drive down elective activity by CCGs, as part of money-saving bids elsewhere across the country.

But an information note to local GP practices claimed the ‘Population Health Scheme’ would also reduce ‘unjustified variation in primary care across practices and within practices’.

The document said: ‘The value of the scheme for each individual GP practice will depend upon the weighted list size. Practices will be paid based on the achievement of indicator thresholds.

‘For every one "point" a practice achieves, they will be awarded 1% of the money available to them under the scheme.’

It added that the scheme was ‘key to eliminating inequitable care for the patients of Lewisham and ensuring scarce resources are used appropriately’.

Regarding cutting referrals, the note said GPs who ‘achieve or are below [the] average practice referral rate’ will be awarded with extra funding, while a further 10% can be obtained if the practice achieves the average referral rate for their 'neighbourhood'.

Lewisham has 43 GP practices, organised within the One Health Lewisham GP federation. Within the federation, practices form four neighbourhood clusters, each with between seven and 12 practices. 

Lewisham LMC chair Dr Simon Parton told Pulse that they had urged ‘greater emphasis on supporting GPs to share best practice, in order to improve the quality of prescribing and referrals, rather than relying so heavily on targets'.

He added: ‘Lewisham LMC encourages practices to use NHS resources and referral pathways appropriately, while always putting patients’ best interests first.’

The CCG and GP federation said in a joint statement: 'GPs will continue to make referrals based on their clinical assessment and the patient needs.

'The Population Health Scheme aims to resource and support the transformation and cross-practice working which is currently not a contractual requirement.

'We are passionate about ensuring that all Lewisham residents have access to equitable care regardless of which practice they are registered with.'

CCGs came under fire last month after it was revealed that several of the 'cash for cuts' schemes revealed by Pulse in Februrary were still in place.

According to the BMA, schemes with payments dependent on referral decisoins 'create a conflict of interest, which would be unethical and may undermine the doctor/patient relationship'.

Full list of targets

  1. Reducing over the counter (OTC) medications prescribing (6 points)
  2. Increasing prescribing decision support tool Scriptswitch utilisation (6 points)
  3. Reducing prescribing of low priority medications (6 points)
  4. Engagement with One Health Lewisham pharmacy support (3 points)
  5. Implementation of best practice in pathology ordering (4 points)
  6. Reducing variation in pathology ordering (within practices) (5 points)
  7. Reducing variation in pathology ordering (across practices) (5 points)
  8. Implementation of best practice in outpatient referrals (4 points)
  9. Reducing variation in outpatient referrals (within practices) (10 points)
  10. Reducing variation in outpatient referrals (across practices) (10 points)
  11. Engagement with ‘high-intensity user’ team (2 points)
  12. Increase in the coverage of flu vaccination for over 65s (2 points)
  13. Increase in the coverage of flu vaccination for all risk adults (2 points)
  14. Increase in the coverage of flu vaccination for pregnant women (2 points)
  15. Increase in the coverage of pneumococcal vaccination for over 65s (2 points)
  16. Increase in the coverage of pneumococcal vaccination for at risk adults (2 points)
  17. Engagement with 3TTs diabetic team (2 points)
  18. Achieve all three NICE recommended treatment targets for diabetic patients (4 points)
  19. Completion of Macmillan cancer toolkit modules (6 points)
  20. Improving two week wait cancer referrals (2 points)
  21. Conduct physical health check for SMI patients (14 points)
  22. Send two patient representatives to borough-wide meeting (1 point)

Source: NHS Lewisham CCG

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Readers' comments (9)

  • how about dealing with the elephant in the room: we are here because of austerity cuts over the past 7 years to the public sector as admitted to officially-as if it needed proof!

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  • Okay so if we refer nobody and issue no prescriptions then the government will be very happy at the savings made. Of course as a result people will die younger so further savings made by reduced pension and benefits payments needing to be made by the Treasury!
    So everyone is happy and therefore less need for antidepressants (or ketamine sprays) as a result!!

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  • Some of these targets are reasonable but the package as a whole stinks of an accountants solutions to improving health care. Investment needs to be made in stabilising practices to improve continuity of care concurrently investing in education, knowledge and skills training to improve diagnosis and management: The evidence for this approach is there from many countries, notably Finland. The evidence for what will turn out to be more cuts in services for patients and resources in practices will be a further erosion in the quality of primary care with little incentive for doctors to join or be retained in primary care.

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  • Morally bankrupt

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  • 'Commercially sensitive' often means 'we are not going to tell you because it is a bit dodgy'

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  • When are these stories finally going to make the nationals? It's scandalous this goes on. These schemes are clearly a conflict of interest and must not be allowed. I would like to know the colleges position on this?

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  • The silence from the College and the BMA id deafening!

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  • For heavens sake - when will we learn.

    It is impossible to justify to patients (or the Daily Mail) the use of financial incentives to restrict access to care.

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  • GMC is asked to take into account system failure
    So no worries when things go wrong as a result ??!!!

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