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GMC advises caution over referral incentive schemes

The GMC has advised doctors to think carefully about joining controversial referral reduction incentive schemes for cutting referrals - but has refused to intervene to block schemes which GP leaders fear are ‘unethical’.

GPC chair Dr Laurence Buckman wrote to the GMC earlier this month to call for an end to controversial schemes that offer GPs financial incentives for altering their referrals and prescribing behaviour.

In a written response to Dr Buckman, GMC chair professor Peter Rubin said doctors ‘must act in the best interests of patients when making referrals and providing or arranging care’ but stopped short of calling for existing schemes to cease.

In a letter to Dr Buckman, he said: ‘Any scheme which results in care to patients being compromised will be in breach of our guidance both in relation to accepting incentives, and on the duty to provide a good standard of practice and care.’

He said doctors ‘must not ask for or accept any inducement, gift or hospitality which may affect or be seen to affect their decisions.’

The kind of schemes flagged up by the GPC as being potentially ‘unethical’ involve GPs being set arbritary targets to reduce prescribing, A&E attendance and referals. In some areas, CCGs are paying GPs a set sum per patient for reductions in urgent care, elective care and prescribing, while the GPC has also raised concerns over the planned ‘quality premium’.

Dr Simon Poole, deputy chair of the GPC’s commissioning and service development subcommittee, called for stronger guidance from the GMC. ‘I will welcome greater clarity from the GMC because I think that some of the schemes that are around may absolutely cross that threshold where GPs and practices are put in an absolutely impossible position.’

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