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Plan to fine GPs if patients use A&E is ‘unworkable’

By Gareth Iacobucci

Plans to fine GPs every time their patients use A&E or walk-in centres have been branded ‘unworkable' and ‘perverse'.

The Government is considering controversial proposals – which could form part of Lord Darzi's NHS review this summer – to charge back to GPs the treatment costs of patients who visit A&E, walk-in centres and minor injury units. The idea is born from a belief that poor access to GPs is leading to more patients using these services.

Pulse understands ministers have asked the NHS Confederation to investigate the possibility of a tariff for walk-in-centres, minor injury units and temporary residents, which GPs would be billed for.

David Stout, director of the confederation's PCT Network, said it would welcome discussion of a system of ‘money following the patient'.

GPC chair Dr Laurence Buckman said charging the costs of inappropriate use of A&E services back to GPs was a bad idea in both theory and practice. ‘There is a finite amount of money given to practices to provide services. Taking it away by charging back costs if patients went to A&E or elsewhere would not be an incentive, it would be a punishment – a disincentive to work in areas with high A&E use.'

Professor Chris Salisbury, professor of primary care at the University of Bristol and a GP there, who has previously researched the impact of walk-in centres on emergency admissions, said the plans were ‘unlikely to be effective at improving access to GPs, and could lead to perverse disincentives'.

He added: ‘It's more likely to incentivise GPs to get rid of people who go to A&E a lot, because it will be costing them.'

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