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GPs face further referral cuts of up to 10% as trusts fall behind on QIPP targets

Exclusive: GPs are facing a new round of efficiency targets and swingeing cuts to referrals until the end of the financial year as PCTs and clinical commissioning groups fall behind on QIPP targets, a Pulse investigation has revealed. 

Our analysis of financial papers across 34 trusts shows GPs and managers are struggling to get to grip with the daunting efficiency savings required of the NHS, with almost three quarters currently missing year-to-date targets.

It comes just weeks after MPs on the health select committee warned ministers that the move to GP-led commissioning was undermining the drive to achieve £20 billion in efficiency savings by 2014/15.

In total, the 34 PCTs estimated a net overall shortfall of £54.9m against year-to-date targets. Of 24 trusts to give an end of year forecast, 16 were predicting a shortfall, with a forecast net overall shortfall of £23.8m. 

In southwest London Kingston CCG, which has a current shortfall in QIPP savings of £155,000, has announced plans to cut GP referrals by a further 10% between now and April through a new referral management scheme in order to try and meet its targets.  

PCT minutes said: ‘The remaining gap will be closed through the addition of a referral management scheme. The project plan to be based on a 10% reduction in GP referrals with a financial saving of £975,000 for year end. The addition of the referral management scheme is expected for month five reports with 11/12 impact at quarter four giving estimated savings of £250k.'

NHS North Central London, where five PCTs are currently battling a combined QIPP savings shortfall of £6.4m, has vowed to focus on ‘proactive demand/referral management as part of integrated care and unscheduled care programmes.'

NHS Sussex, which forecasts a £14.1m shortfall in QIPP savings by the end of the year, said it would be ‘escalating the pace and spread of existing schemes' and ‘identifying quick wins'. It said further reductions in referrals to secondary care would be targeted through ‘improved care pathways, clinical thresholds and procedures of low clinical value, referral management and triage'.

But Dr Richard Vautrey, GPC deputy chair, warned it was vital CCGs did not focus exclusively on areas like GP referrals.

He said: ‘What we need to guard against is CCGs falling into the trap of just plucking the low hanging fruit when it comes to QIPP savings and making short-term adjustments that can't be sustained, or trying to put demand management processes in place that don't really have any longevity.'

‘What we haven't been able to do yet is any meaningful engagement with some of the big questions about service redesign, how many hospitals we've got and how we can make really quite serious changes.'