Referral cash may distort patient care
The Government is risking reducing the quality of patient care by incentivising GPs to change their referral behaviour, according to leading primary care academics.'Interventions that change the referral behaviour of GPs generally reduced outpatient activity but also risked reducing quality,' the evaluation of care closer to home concluded.Researchers warned referrals under practice-based commissioning would need to be carefully audited, to ensure PBC was not acting as a perverse incentive to reduce appropriate referrals.The National Primary Care Research and Development Centre team concluded that though financial incentives had been shown to reduce referral rates, 'there is a high risk that reduction may apply to both necessary and unnecessary referrals'.Dr Ruth McDonald, a research fellow at the centre and member of the evaluation team, said: 'If you give someone an incentive for referrals it does lead to inappropriate referrals. With any system that offers incentives, or allows GPs to keep the savings made, there is a likelihood for that to happen.'Dr McDonald said systems like commissioning consortiums, referral audits and PCT performance frameworks would need to be in place to monitor the impact of commissioning.The review was published in the Journal of Health Services Research and Policy this month.