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How commissioning would solve cynical referral ruse

From Dr ML Milner

Saltburn, Cleveland

Regarding '''Cynical" GPs accused of referral ruse' (20 April): this problem would be solved by commissioning practices being given a needs-based budget for the services they commission rather than a historically based budget.

Historically-based budgets reward high referral rate practices and disadvantage those that have always tried to manage demand, particularly into the secondary sector.

The Department of Health in deciding upon historical budgets has disadvantaged the careful referrer and rewarded the very activity ­ over-referral ­ which the reforms are in part aimed at solving.

The problem of apparently higher activity in the run-up to practice-based commissioning budgets being set could easily be solved by simply discounting the last year and taking an average of say the previous three years.

Some more thought needs to go into budget setting for practices because not to do this will simply put even more inequality into the system.

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