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GPs continue to be offered 'questionable' incentives to reduce cancer referrals

Exclusive CCGs are continuing to financially incentivise GPs to reduce urgent cancer referrals despite being told not to by NHS bosses, Pulse can reveal.

Despite NHS England pledging to crack down on the practice, neither of the two CCGs unveiled by a Pulse investigation to be paying for lower cancer referrals have decided to amend schemes.

NHS Lambeth CCG has reviewed its incentives scheme, however upon finding that the number of two-week cancer referrals had increased in the first six months of 2015/16, it decided it would not make any mid-year changes.

NHS North East Lincolnshire CCG told Pulse that it has neither conducted a review nor changed its scheme.

The Lambeth referral scheme offers payments for practices moving towards the average 2014/15 CCG referral rate per 1,000 patients.

And the CCG told Pulse that urgent care and two-week cancer referrals ‘cannot be separated’ from the overall numbers.

An NHS Lambeth CCG spokesperson said: ‘In light of recent publicity, it became apparent that the objectives of our work on referral practice may have been misinterpreted. Therefore the CCG took the decision to review the scheme.

‘The outcome of this review showed that between April and September 2015, our two week pathway for cancer referrals had increased by 13% compared to the same period last year. Therefore we are not proposing any in-year changes to the scheme.’

The spokesperson added that the CCG ‘wants to, and continues to, actively promote good referral practice’.

In North East Lincolnshire, an average practice currently receives an incentive of over £6,000 for reducing outpatient referrals to the same level as the 25% of practices with lowest rates in the previous financial year. It includes two-week wait and urgent referrals but excludes a GP referring directly for an emergency admission.

The CCG said the scheme ’has not changed the scheme however it has reviewed various concerns raised following the article by Pulse about the potential for unintended adverse impacts’ and that ’concerns raised in and following the article would be taken into account when taking decisions on any future incentive schemes’.

Dr Peter Melton, CCG clinical lead, confirmed the scheme had been discussed thoroughly with clinical, lay colleagues and other stakeholders.

’The result of that review has been that we have been able to provide assurance that those concerns are not being seen in practice within North East Lincolnshire.’

An NHS England spokesperson declined to say whether they had investigated the schemes further, and repeated an earlier statement saying: ’NICE has set out evidence-based guidelines for when patients should be referred, and no CCG incentive scheme should in anyway cut across that.

’We have contacted each of the CCGs mentioned to ensure this has been clearly communicated to all practices and will continue to monitor the situation.’

Pulse’s findings, published in September last year, included at least nine CCGs which were offering practices payments to cut referrals.

Although the GPC said many of the schemes could be ‘ethically questionable’, NHS England specifically said CCGs would be told to ensure that their incentives scheme did not affect cancer referrals.

It comes as Government policy is to actively encourage patients to access early investigation to improve cancer survival rates, as these are currently lagging behind other countries.

NICE has slashed referral thresholds this year hoping to boost early diagnosis and the Government’s ‘be clear on cancer’ campaigns have been shown to significantly increase the number of patients seeking GP advice.

Readers' comments (7)

  • Are we really expected to believe that they cannot disagregate the number of standard referral numbers from 2 week wait referrals? It shows the state of IT training and support in South East London which is provided by the CSU. Any fool could have ensured that the different referrals were coded differently and built the correct searches.
    As for the CCG assuming that a 13% increase in 2ww referrals suggests there is no problem is weak as we don't know what it would have been without the incentive. They should be addresssing this unethical priniciple and not just the apparent effect.

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  • Yet another attempt to smear poor old doctors for doing something they have absolutely no control over.

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  • It shows a lack of discussion with the CCG and member practices.

    Any incentive to reduce referral in terms of absolute numbers is potentially miselading for patietns.

    The new cancer guidelines want us to refer more patients on a 2ww. Why take the risk of complaints (being struck off) and not referring someone!

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  • There has been a downward pressure on all referrals by CCGs, it is no surprise that this unethical behaviour exists and is quite likely to be more widespread than those reported.
    Finally a proper job for CQC, in association with the GMC to eradicate this practice, irrespective of excuses, or there is no place in society for all of these organisations.

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  • Hang on. Are we missing an obvious point here?

    How can the CCG claim a 13% increase in urgent referrals if they are unable to count them separately?

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  • I refer anything that vaguly fulfills any of the lower threshold of the new nice guidance.Refer refer refer. You will never have a patient complain or refer you to the GMC for referring or admitting you to hospital. Get it wrong and don't refer/admit and something goes wrong, then you are looking at complaint/gmc/cqc/ombudsmand/police/lawyers/jail. Why risk it. Refer away. save yourself. It costs you nothing and is now considered good patient care to refer rather than not. You sleep much easier as well. Always refer the 50:50 that you think about later in the day/night or when driving in, your gut tells you more than guidelines.

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  • To Anonymous | GP Partner09 Jan 2016 11:42pm
    You are bang on. Until we are covered by the same indemnity as other workers in the NHS, why should we take any risks at all? The more risks we take, the higher our indemnity fees become. And your point about complaints etc is also very pertinent. GPs are expected to support new pathways, limit access to referrals etc, but who supports the GP when the inevitable complaints come in? Nobody, thats who.

    Ditch the contract comrades!

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