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GP practices offered funding to cut cancer referrals in new scheme



A CCG is offering practices incentives to cut all referrals – including cancer referrals – Pulse has learnt.

Pulse’s ‘Cash for cuts’ investigation has found that NHS Rotherham CCG’s ‘quality contract’ scheme incentivises practices to cut referrals by 1% or come down to the CCG average.

However, unlike other schemes uncovered by Pulse, the scheme includes cancer referrals.

Under the quality contract, practices are expected to ‘reflect on current referral behaviour’, including peer review – especially of locums – in a scheme worth £3.36 per patient.

A third of this funding is awarded for meeting the target to cut referrals.

When asked whether this included cancer referrals, a spokesperson said: ‘The quality contract encourages appropriate clinical management of referrals and no referrals are excluded from our data.’

The Rotherham scheme also involves senior GPs being incentivised to check referrals from locums.

In 2015, Pulse revealed that two CCGs – NHS Lambeth CCG and NHS North East Lincolnshire CCG – had implemented incentives schemes that rewarded GPs for cutting cancer referrals.

Under the schemes, NHS Lambeth CCG offered payments for practices moving towards the average 2014/15 CCG referral rate per 1,000 patients while NHS North East Lincolnshire CCG had offered payments that would equate to more than £6k for the average practice to reduce outpatient referrals to the same level as the 25% of practices with the lowest referral rates – including two-week urgent cancer referrals – in 2014/15.

At the time, Dr Robert Morley, chair of the BMA GP Committee’s contracts and regulations subcommittee, said these two schemes were ‘extremely concerning’, adding: ‘These may, at face value, potentially be ethically questionable and conflict with GMC guidance, on the basis that they might conceivably influence individual management decisions.’

But in a recent freedom of information response, NHS North East Lincolnshire CCG confirmed they no longer have any referral incentive scheme in place, while NHS Lambeth CCG said they currently have no target in place for a reduction in referrals.