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DH relaxes rules on QOF referral targets

By Lilian Anekwe

Exclusive: GPs will be offered a workaround so they can earn points under the QOF's new quality and productivity indicators without hitting requirements to the letter after officials admitted the targets were unworkable in some areas.

A Department of Health national director conceded many GPs were unable to reshape care pathways to reduce referrals because the presence of referral gateways had taken away pathway control from practices.

NHS Employers told Pulse that GPs who were unable to bring about any change to care pathways because of the presence of gateways would still be able to claim points as long as they documented the situation.

The new QOF indicators require GPs to review referrals and identify 'service design improvements' that will reduce GP referrals to secondary care.

Indicator QP8 offers 11 points if 'the practice engages with the development of and follows three agreed care pathways for improving the management of patients in primary care to avoid inappropriate outpatient referrals and produces a report of action taken to the primary care organisation no later than 31 March 2012'.

A separate indicator, QP7, awards five points if ‘the practice participates in an external peer review… and proposes areas for commissioning or service design improvements'.

But GPs in areas where PCOs use referral gateways to screen referrals for procedures such as orthopaedics, hysterectomy and IVF have claimed they will not be able to exert any influence over the redesign of services. In some areas with 'total referral management schemes', every single referral goes through a gateway and as many as one in eight are diverted or rejected.

Dr Mike Warburton, a former GP and the DH national programme director for GP access, told delegates at a Primary Care Commissioning event in London last week that the criticism was justified: 'It's a really good point and we do need some clarification on this. I will be pushing for it very hard.'

A GP working within NHS South West Essex who did not wish to be named told the conference: 'Every single referral in my area is screened by the referral gateway. So there's nothing we as GPs can do to alter the pathway – reducing referrals is out of our hands.'

NHS Employers said in a statement: 'During external peer review, practices should identify any areas for service design which are then raised with the PCO.'

'This could include suggestions about how a referral management centre is used. It may be there are no areas for improvement, in which case the practice should state this. As long as it has adequately carried out external peer review, it would be eligible for payment.'

But Dr Krishna Chaturvedi, a GP in Southend-on-Sea, Essex, said the new QOF indicators would increase GPs' administrative workload.

'I feel patient care involvement will be less because of all the bureaucracy we're going to have,' he said.

GPC deputy chair Dr Richard Vautrey said: 'If there is no other option than to use a referral gateway for all referrals, that in itself should fulfil the requirements. But I would be very surprised if that were the case.'

Hysterectomy surgeries are on the list of services that could be cut