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Tough GPC guidance urges GPs to shun referral incentives

By Nigel Praities

GPs must not sign up to targets or accept any direct payment to reduce their referrals, says strict GPC guidance released today.

The document fires a shot across the bows of LMCs and practice-based commissioning groups who are signed up to incentive schemes, but has been branded as unrealistic by some GPs.

The guidance says all schemes must be ‘clinically appropriate' and not provide ‘perverse incentives' to reduce referrals to secondary care, warning GPs may otherwise risk falling foul of Department of Health and GMC guidance.

‘All referral analysis and demand management schemes must only explore or promote suitable alternative pathways of care which are acceptable to the patient. They must not contain an incentivised, target-based element,' says the guidance.

GP chair Dr Laurence Buckman said it was not acceptable for GPs to accept financial rewards to reduce patient referrals by fixed amounts.

‘We understand in some areas of the country referrals are rising, putting extra financial pressure on the NHS. But health managers must not seek to tackle this by setting up target-based schemes. All referrals must be driven solely by the patient's best interests,' he said.

Oxfordshire PCT operates a controversial scheme where practices are incentivised for delaying and meeting a set monthly target for referrals.

Dr Paul Robin, chief executive of Berkshire, Buckinghamshire and Oxfordshire LMCs, said he disagreed with the guidance.

‘It will probably make GPs and PCTs wary of signing up to the second component of the Oxfordshire scheme, where payments are made for reducing referral rates.

‘But there is nobody handing out money when PCTs get into trouble. Trusts have to deal with what they are given and we have to help them do that.'

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