GPs are being offered a £30 ‘administration fee' for cancelling outpatient follow-up appointments and doing the work themselves, in the latest scheme by clinical commissioning groups to tackle hospital waiting lists.
The scheme in encourages GPs to go through outpatient letters and ask patients if they would prefer to be seen in the practice rather than in hospital. But, controversially, the £30 payment is only given once the follow-up appointment is cancelled.
GP commissioning leaders have welcomed the scheme as an exemplar for the whole country to avoid ‘unnecessary' hospital outpatient appointments and reduce costs. But the GPC said it created the potential for ‘perverse incentives' and reduced trust in the profession.
Payments under the pilot QIPP scheme are being offered to five practices in Coventry for reviewing appointments and auditing whether patients go on to have another hospital appointment. The rollout comes despite a similar scheme trialled in neighbouring Rugby suffering from low uptake from GPs.
CCG leaders say the scheme is designed to create ‘vacant slots' to reduce hospital waiting times and was designed with advice from a medical defence body to ensure any legal risk is minimised.
Dr Robin Lal-Sarin, vice chair of Godiva CCG, said: ‘It's about trying to get the patient seen in the most appropriate place. A lot of elderly patients prefer to see their GP, its closer, so they don't have parking fees or travel costs.'
But LMC leaders said they had not been consulted on the scheme and they had real concerns over the ethics of the scheme.
Dr Jamie Macpherson, secretary of Coventry and Warwickshire LMC, said: ‘We have concerns about the ethics behind this; asking people to alter the care pathway and being seen to pay people to do that.'
‘If you actually exchange money, even an admin fee, it puts things on a different footing. There should be no financial inducement for changing care pathways.'
GPC negotiator Dr Chaand Nagpaul said the scheme would lead to the perception of a conflict of interest for GPs.
He said: ‘It has the potential for creating perverse incentives, and it would make far more sense to develop clinical pathways that are evidence-based and clinically focused.'
‘Cancelling appointments is not a logical way to approach this. Patients are not in a best position to judge the most appropriate location for a follow up appointment.'
Dr David Shore, a GP who refused to take part in the Rugby pilot of the scheme, said he feared the scheme would be ‘very damaging' for the professional reputation of GPs in the area.
‘We are generalists, not specialists. To be asked to assume specialist follow up without specialist training is a recipe for disaster,' he said.
But NHS Alliance chair Dr Michael Dixon welcomed the scheme, saying it was crucial to tackle the ‘huge sums of money' used on unnecessary follow-ups in hospital.
He said: ‘If Coventry can show they have made savings and patients and the practices are happy, it seems to me ludicrous to criticize.'
‘A GP's role prior to the health bill was to be an advocate for the individual patient. That has changed. GPs are now also the guardian of the health of the whole population, which means the guardians of limited NHS resources.'
A medical defence organisation's advice
‘The patient's best interests must always be the top priority when providing medical care,' said Dr Stephanie Bown, Director of Policy and Communications at the MPS.
‘All clinicians have to make a judgement about their competence in relation to the scope of their practice on a daily basis.
‘In these circumstances, the GP will need to make a judgement on whether to offer to provide the follow-up care based on their knowledge of the patient's condition - subject to it being within their field of competence - and provided this is what the patient wants.
‘As in all aspects of their practice, GPs remain accountable and legally liable for the consequences of the care that they provide.
‘The GMC's guidance ‘Good Medical Practice' makes it clear that doctors must not accept any inducement which may affect or be seen to affect the way they treat patients. However, a nominal administration fee is very unlikely to amount to a financial inducement.'