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GPs to be 'rewarded' for cutting down referrals

A London CCG is considering introducing ‘local budgets’ for GPs to cut back on referrals, which it says will ‘reward more effective management’.  

NHS Bexley CCG said it is considering a raft of measures to cut referrals, including incentivising practices to peer-review each referral, increasing ‘primary care investigation’ before referrals and encouraging acute providers to reject inappropriate referrals.

It said it is taking the measures after a 16% spike in referrals last year.

But the LMC has said that the CCG is placing the blame on GPs when the real reasons for the increase in referrals is extra patient demand and a lack of clinical pathways for some conditions, which can result in providers having to go back to a GP for further referrals for supporting tests.

The 16% increase in referral numbers emerged when Bexley CCG compared GP referral activity in 2013/14 with that in April to September for 2014/15.

The CCG said in board papers that, ‘given the rise reported in recent months and the significant risk to commissioned budgets’, it would have to develop a ‘further range of strategies to manage demand’.

It said it was considering the ‘introduction of locality budgets for elective activity, which will reward more effective management by practices’.

Other initiatives included ‘incentivising practices to peer-review each referral’ and the ‘use of mandatory care pathways, requiring specific ‘work-up’ and primary care investigation, before referral

A CCG spokesperson added: ‘We are currently reviewing data and working with practices to identify the most appropriate actions and will be giving further updates to the governing body as work progresses. Ultimately the CCG will work with practices to ensure that referrals provide the best possible outcomes for patients.’

However, a statement from Londonwide LMCs and Bexley LMC said: ‘The value judgement that an increase in GP referrals is a cause for concern is questionable, hence the LMC is actively in dialogue with the CCG regarding their perception that the data may in any way be reflective of poor or inappropriate referrals by the GPs in Bexley and to explore how they can support GPs in managing these rising demands.’

It adds: “We have always had a progressive and open approach to referral management and are wholly supportive of sustaining good referral practice reflecting good clinical care. This has been achieved through the engagement of peer review and a referral management and booking service.’

Readers' comments (22)

  • Doctor A decides to refer all the patients he sees on a Monday to the specialists.

    Doctor B from the same surgery (Dr A's peer) reviews on Tuesday all the patients whom Doctor A planned to refer and decides that they can all be managed in Primary Care.

    Does this mean that their surgery will now be incentivised for avoiding all the referrals for Dr A.

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  • Unethical and increase in GP workload as patients will keep returning back to GPs with ongoing symptoms- eventually a referral will be made- all wasting time for patient and GP appointments. We are already good at assessing and managing the uncertainties of patients symptoms. Any further barriers are not good for patients or primary care. Unethical.

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  • Has anyone found robust evidence that high elective referral rates are poor practice? Thought not.

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  • I agree with 1950 - we should be rewarding good healthcare - not good cost savings.

    Since when did the priority change over?

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  • 8.29pm
    The priority changed over about 5 years ago when th coalition started to wind down the NHS.Ethical practice no chance th commisars are in charge.

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  • I thought the patient charter said every patient has a right to see doctor of their choice, including specialists? This is dangerous for GPs.

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  • patients already know 'it's just about the money', this just makes it all worse. unethical and terrible business model. once again placing blame where it shouldn't be (on primary care)

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  • They can keep the money. No money in the world is worth the increased risk of complaints, lawyers or GMC referrals or ones career. I'll refer every patient I think is appropriate to refer and if they are triaged out, the responsibility clearly lies with blocker. Will even start writing this in my letters. Anyone who signs up to this is either naive or just an idiot.

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  • This is terrible and quite inappropriate for all the reasons given above, but everything in this world is ultimately based on money, regardless of who takes the blame when patients and the media complain.

    We have seen nothing yet. Wait till the remaining 60% of austerity measures come in shortly. And of course the Politicians will make sure that it is the clinicians who are blamed for the cuts. e.g "Clinicians need to adopt modern more efficient ways of working"

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