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Independents' Day

Labour calls for urgent review of GP referral incentives following Pulse investigation

Leading MPs have called for a national review of CCG schemes financially rewarding GPs for reducing referrals in light of a Pulse investigation.

The research, which showed at least nine CCGs are offering payment for keeping within targets for outpatient referrals and follow-ups, including urgent cancer referrals, has prompted the Labour Party’s new shadow health secretary Heidi Alexander to call for mininsters to ‘review the impact and extent’ of these incentives ‘as a matter of urgency’.

House of Commons health committee chair Dr Sarah Wollaston also spoke out, calling for the GMC to ‘look carefully’ at all of the schemes.

Ms Alexander issued a statement which said: ’Patients must be confident that their GP will always act in their best interests. Financial rewards for denying patients access to care are wrong and risk damaging that trust between doctor and patient.

’Ministers must now review the impact and extent of these incentive schemes as a matter of urgency.’

She added that this was further evidence against the Government’s claim that the NHS can safely save £22bn by 2020, a point she made in her speech to the Labour Party Conference earlier in the week.

She said: ’The Government plans to make £22 billion worth of efficiency savings in the NHS by 2020, and this is just further evidence that savings on this scale cannot be delivered without harming patient care.’

Dr Wollaston, Conservative MP for Totnes in Devon and a former GP, said on Twitter: ’The @gmcuk needs to look carefully at all these schemes and act to protect patients.’

But Swindon GP Dr Gavin Jamie responded: ’What power does the GMC have to influence schemes set up by managers? Best it could do is tell doctors to ignore them.’

Also responding to Dr Wollaston’s tweet, Dr Stacey Munro, a GP in Portsmouth, said: ’Maybe the Government needs to look at funding healthcare properly… and if it can’t fund be honest with the public about limitations of NHS. Stop blaming GPs.’

Glasgow GP Dr Margaret McCartney commented on the story via her Twitter account, saying: ’It’s not trust in GPs that should be harmed… it’s trust in the politicians running the NHS.’

Sean Duffy, national clinical director for cancer at NHS England said: ’We explicitly want to increase not deter appropriate referrals for cancer checks so as to ensure earlier diagnosis.

’But for some other conditions there’s clear evidence that by boosting funding of GP services, patients can get better care at their local surgery and avoid the need to go to hospital outpatients. The critical thing is to distinguish the two situations, which all GP-led CCGs must now ensure happens.’

Readers' comments (7)

  • Vinci Ho

    Dr Wollaston, Conservative MP for Totnes in Devon and a former GP, said on Twitter: ’The @gmcuk needs to look carefully at all these schemes and act to protect patients.’

    Sorry ,Sarah, rephrase it please
    'My party needs to look carefully at these schemes and act to protect patients .' and don't forget what I said about how you should treat your party!

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  • well done all - this has got more media exposure - 'Plans to reward GPs for cutting hospital admissions attacked as 'preposterous and unethical'' than the junior doctors and as for GPs debating on mass resignation which got no media exposure. we can't win - what ever 'idea' comes out in the NHS - we get the blame. I'm tired of it - can't we go the way of the dentists please? they never get mentioned in the press unless it's doing some celebrity teeth. we can then get on with providing care to our patients - I'm fed up with the NHS now.

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  • Ivan Benett

    I don't think the issue is blame, rather the very wide variation there is between practices and within practices in terms of referrals. Downward pressure on unnecessary referrals needs to happen, but not by incentives. This simply gives the impression that GPs are being bribed to prevent referral and will end up in needless arguments with patients. Peer review is an effective educational intervention to help level out referral numbers. Also having a gateway, with peer triagers who can offer advice is also helpful. Advice lines and email can also help.
    We have resisted referral quotas in our CCG (Central Manchester) as we don't believe they are the right way of going about this.
    The other concern is that the low referring individuals are actually missing serious disease. We have tried to help them too through education, but they are harder to reach.

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  • Well I have worked in 3 practices over time and all clinical staff involved have found peer review to be an utter pointless exercise but of course the sun may shine differently in the parallel universe above.

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  • The spin is against doctors again side tracking the media and everyone else from the junior doctors hours debate.
    Don't worry soon there no NHS and these incentives will be forgotten as a thing of the past.

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  • Ivan.they don't just give an impression GPs are being bribed.they are
    Sarah.the GMC is not implementing this immoral tweaking of GP~ behaviour.GPs themselves are complicit
    Margaret M..those who are cashing in are GP is they who don't deserve trust and will not get when enough the public finds out what has been happening covertly

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  • I agree with Ivan. There is huge variation between practices in referral rates and this must indicate there is something that practices are doing differently than each other. I admit that although I pride myself on referring appropriately there are times where I make referrals that may not be necessary - usually when under pressure and not wanting to make a clinical error. The worrying thing for me is when some GP colleagues have the arrogant attitude that they never refer inappropriately and are not willing to reflect on their practice. An answer is for primary care to be funded to provide a wider range of services and to make GPs within networks of practices accountable to each other for using these specialist resources appropriately.

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