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PCT incentives are driving down hospital referrals

By Nigel Praities

PCTs with controversial schemes to pay GPs for cutting referral rates have bucked the national trend by successfully driving down the number of patients who end up in hospital.

Figures obtained by Pulse reveal trusts across the country are seeing leaps in GP referrals of more than 10% for the second successive quarter as the crisis threatens to plunge parts of the NHS into deficit.

But trusts at the centre of a storm of controversy over schemes rewarding GPs for referring less often to hospital claim to have been reducing the numbers by hundreds every week.

Oxfordshire PCT, which has offered its GPs rewards totally up to £1.2 m in a desperate bid to cut referral rates, told Pulse the scheme had cut the figures dramatically.

‘The scheme and raising awareness within primary care has had the impact of reducing referrals from 1,500 a week in July to 1,100 a week in October,' said a spokesperson for the trust, which brought in the scheme to try to stave off a £22m projected overspend.

NHS East of England, in which PCTs targeted referrals after a 13% year-on-year increase in the first quarter of this year, said it had cut referrals in the second quarter by 1%.

Dr Shane Gordon, a GP in Colchester and associate medical director at NHS East of England, said: ‘We have seen GP referrals drop by 1,000 a month,' adding referral incentive schemes were thought to have been a major factor.

The BMA has warned GPs against taking up incentives to cut referrals, although it has given the green light to schemes paying GPs only to review their referral practice.

But Pulse has learned the pockets of success at driving down referrals come against a backdrop of continuing and alarming increases in many other areas – with some trusts forced to take drastic action to prune back primary care budgets.

NHS West Midlands said it had seen a 16% year-on-year increase in quarter two of this year, almost as dramatic as its 18% increase in quarter one. A spokesperson said: ‘We are aware the national trend in GP referrals is upward.'

Evidence is emerging that PCTs without referral schemes may be faring worse than those that have them. Despite the overall picture in NHS East of England, NHS Bedfordshire, which does not have a referral incentive scheme, said its quarter two figures showed an 11% increase.

Sheffield PCT reported an 8% year-on-year rise, compared with a 10% year-on-year increase in quarter one, but claimed referral schemes in its area were beginning to make an impact.

Hampshire PCT, which has also attracted controversy over its referral incentive scheme, said the figure was again up in the second quarter but the increase had slowed.

Dr David Jenner, practice-based commissioning lead at the NHS Alliance and a GP in Cullompton, Devon, said: ‘I believe we are seeing a decline in referrals. With more of a focus on referrals, you would expect GPs to review theirs more closely. But it is an open verdict whether this is due to referral incentives.'

Dr David Colin-Thomé, the Department of Health's primary care tsar, said: 'GPs have a duty to ensure that patient referrals are based on clinical need - it would be unacceptable for referral management schemes to undermine clinical decision-making.

'It is quite right for local Primary Care Trusts to examine GP referral patterns in their area to ensure that patients receive the best care in the right place – there is no evidence that this is affecting patient care.

'I have written to Strategic Health Authorities to reinforce the importance of ensuring that any local schemes promote the most clinically appropriate care.'

Referrals crisis hotspots

East Of England SHA – GP referrals down 1% year on year in Q2 compared with Q1 jump of 13%

West Midlands SHA – 16% rise in referrals in Q2

Sheffield PCT – Referrals up 8% on last year

Oxford PCT- referrals slashed from 1,500 a week in July to 1,100 a week in October

Controversial PCT incentive schemes are driving down referrals

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