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GPs to be offered 'perverse' incentive for reducing emergency admissions by 10%

Exclusive GPs in one area are being incentivised to achieve a 10% reduction in emergency admissions this winter, which the GPC warns was a ‘potentially dangerous’ scheme that could ‘undermine the patient-doctor relationship’, Pulse can reveal.

The ambitious scheme has been rolled out by NHS Doncaster CCG in response to pressure to reduce hospital admissions, and will give practices the chance to earn up to £2 a patient.

The local LMC said it recognised it as a ‘perverse incentive’ for GPs but was ‘trying to be positive’ about the potential to access the extra funding.

This is the latest CCG scheme to link payments to emergency admissions, after a Pulse investigation found that NHS West Suffolk CCG and NHS Ipswich and East Suffolk CCG are linking funding worth £5 per patient to outcomes.

NHS England’s ‘cash for diagnoses’ dementia scheme has similarly been criticised for putting GPs in a difficult position as their clinical decisions are viewed by patients as being influenced by financial interests.

Under the NHS Doncaster CCG scheme, local GP practices managing to achieve a 2% reduction in unplanned admissions in January to March 2015 compared with the same period in 2014 will receive 40p per patient.

They will receive a 40p-per-patient incremental increase for every 2% further reduction up to £2 a patient for those reducing admissions by 10%.

Doncaster LMC chair Dr Dean Eggitt said: ‘On the negative side, there is now a perverse financial incentive to drive down unplanned admissions. That is the problem with the direction of travel for commissioning at the moment, that everyone wants to do outcomes-based commissioning.’

However, he added that he ‘tried to be quite positive’ about the initiative to reduce unplanned admissions.

He said: ‘From our CCG’s perspective I actually see it as a very welcome step really; that they’ve tried to invest more money in primary care, for a good reason. I just hope that GPs remain quite clear about what their job is, rather than chasing the finance.

‘Hopefully we will have done enough work to have affected unplanned admissions over the winter period.’

But GPC deputy chair Dr Richard Vautrey said this was the type of scheme that the GPC has ‘fought against’ being rolled out on a national level in the past because of their risk to GPs.

He said: ‘We would not support such schemes and successfully fought against a similar scheme being implemented nationally in the past.

‘As with the dementia enhanced service these simplistic but potentially dangerous schemes could mean patients doubt the judgement or motives of their GPs when a referral is not made as they expected or wanted and they undermine the doctor-patient relationship as a result.’

A spokesperson for NHS Doncaster CCG said: ‘This winter we are proposing to commission for improved outcomes by rewarding primary care teams for providing good quality care.

‘The scheme is focused on rewarding practices for providing high quality primary care to the most vulnerable people in our community. The CCG operates from a position of trust with our GP colleagues and believe they will exercise sound clinical judgement in all circumstances. If this was found to not be the case with any individual we would address the issue through the appropriate route.’

Readers' comments (17)

  • why is pulse accepting quotes from un named sources at the CCG?

    You're better then a tabloid - if they are un named they shouldn't be quoted

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  • Bob Hodges

    This will always occur whilst GPs are paid on pluck contracts rather than in IOS tariff.

    'Underspending' is an active process. It doesn't just happen and it requires additional 'work' by GPs. That should be paid, but how do you do that if not this way?

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  • Vinci Ho

    There are differences between the dementia DES and this , the former was a carpet screening in short space of time, the latter is reducing hospital admission if indicated.
    But the question is still ' is it really safe to keep this patient away from hospital ?' in each case? Is 10% reduction the realistic but still safe target ?
    As austerity to be carried on as per the Chancellor , there will come to a come where rationality is to be lost sacrificing safety of our patients.

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  • Vinci Ho

    Correction
    ..come to time....

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  • Offer GPs incentives to admit fewer patients and we will admit fewer patients.

    But I can think of at least two questions it raises:

    Will this come at a cost in terms of outcomes?
    Will it lead to more admissions via 999 and A&E?

    I'd like to see a properly evaluated pilot study.

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  • This is insulting.

    It is too short a call to expect this kind of money to make system change which leads to reduced admission. Therefor CCG is assuming at least 10% of unplanned admissions are due to GPs not doing their best. Or they are egging the GPs to take more risks by giving them more money.

    To insinuate I might have admitted less patients if I was offered money is same as questioning my professional judgement and motives.

    To take more risks simply for the money is seriously harmful to patients as well as doctor/patient relationship. I cannot think any sane GP would accept such scheme - but we'll have to see what Doncaster GPs are made of.

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  • Ivan Benett

    Anonymous | GP Partner | 09 December 2014 3:20pm 'This is insulting. '
    There are plenty of ways of reducing unplanned admissions without putting patients at risk. Most are actually about making it safer for patients by proactive care, rather than waiting until people are so ill that they need admission. By that time it's too late and they need to go in.
    For example, better management of people with heart failure - medicines optimisation and heart rate control, early intervention in COPD, stopping people with diabetes going hypo' because of too tight sugar control. Many similar examples. Also care planning, as incentivised in the unplanned admissions DES, will only work if there is care 'planning', rather than just writing a lot of care 'plans'. Making sure that there are no dangerous medication (my own hobby horses are thiazides for treating BP in older patients, NSAIs, and ACEIs in people with CKD without proteinuria)
    Visiting people when discharged to make sure they are stable and other adencies are plugged in.
    Early identification and optimal management of long term conditions including dementia.
    Better end of life planning. Better nursing home care.
    Lots of ways, but we need to get the incentivisation right. It's not simple or it would already be done, but there is little alternative.
    So anonymous, don't be insulted, but start imagining ways that would work for your population.
    By the time people reach A&E it's too late & I'm pretty sure if you look at your patients who are admitted, you'll see ways that the admissions could have been avoided - well some of them anyway.

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  • Vinci Ho

    It is a fine line between politically correct diplomacy and dangerously flawed hypocrisy.........

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  • Ivan,

    Thanks for spelling everything out for me. As I am involved in a lot of what you described, I have already thought about proactive care.

    Perhaps you should read the first sentence of my second paragraph which indicates I have already given this a thought and felt the cash incentive is not aimed at proactive care?

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  • p.s. as I spoke with my locality, where is the evidence care plans decreased unplanned admissions? I'm all for proactive care but no one is yet to show me evidence it actually reduces admissions (several studies in the past to the contrary)......

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