GPs warned: cut referrals or bear brunt of NHS cutbacks

17 Jun 09

Tribal, appointed as one of the Government’s key advisers on healthcare spending, warned PCTs were ‘remarkably tolerant’ of variations in GP referral rates, and said a clampdown could bring ‘very substantial benefits’.

It also warned GP services could face ‘rationalisation’ if practices did not take on complex hospital work, with ‘more cost-effective’ providers such as pharmacists to be commissioned to take on a greater proportion of frontline work.

Tribal has contracts with the NHS worth millions of pounds as a member of the Government’s flagship frameworks on PCT spending and practice-based commissioning, and its advice is likely to be a key influence on Department of Health policy.

Its report came as the NHS Confederation predicted the recession and rising costs would lead to a £15bn shortfall in health spending in the five years from 2011.

A report by the confederation on PCT commissioning, released at last week’s annual conference in Liverpool, called on trusts to review productivity of both GMS and PMS contracts to maximise productivity.

Tribal’s report, Industrial Transformation in the NHS, warned the confederation’s forecasts were if anything optimistic, insisting the NHS must take radical steps to prepare for a deficit as high as £20bn per annum over the next five years.

It argued: ‘Our studies suggest performance across practices varies significantly, with many PCTs remarkably tolerant of variations.

‘It is typical for referral rates to vary by as much as 200%, even taking into account differences in population.’

It added: ‘Making GP practices more efficient deliverers of first-contact care is very attractive, but the benefits are limited by the high and increasing costs of GP treatment.

‘There are savings to be made through rationalisation of first-contact services, in particular shifting first-contact care to more cost-effective providers, which service users often find more convenient and at least of equal quality.’

Report author Matthew Swindells, managing director of the health division of Tribal and former special adviser to then health secretary Patricia Hewitt, said GP services would not face cuts if practices took on more secondary care work.

‘Some 30%-40% of patients in hospital don’t need to be there. There is a huge gain to be made. It needs a step change, not to replace primary care services, but extend what they are doing.

‘If a practice can’t offer the full range of services patients need and is referring large numbers, that would fall into our diagnosis of needing to rationalise services.’

Dr Nigel Watson, chair of the GPC’s subcommittee on commissioning and service development, said the recommendations were ‘hugely simplistic’.

‘It’s a very managerial way of dealing with it. The idea you put GPs on to the second line and others in front of them is total nonsense. It’s not always cheaper.’