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Commissioning dilemma: Being forced to review referrals with a neighbour you don’t trust

You are expected to review local outpatient referrals with local practices under the QOF, but you have a difficult working relationship with your nearest neighbour, whose clinical judgment you don't trust. What do you do if your PCT insists you work together to collect your QOF points? Dr Gary Calver advises

This question highlights one of the greatest challenges of General Practice. Regulators and the profession have struggled to identify and effectively remediate what has been termed "poorly performing practices".

One aspect of the proposed reforms now places the responsibility for quality in primary care with the consortia and by inference to the local GP community. If there are doubts about the clinical skills and care of a neighbouring practice then there is a responsibility under GMC guidelines (Good Medical Practice para 43) to bring the problems to the notice of the PCT.

In order to effectively deal with the underperforming practice there must be objective evidence or sufficient concern that further investigation by the regulators will identify areas of concern. The choice is stark, you either have to recognise that the concerns that you have are serious enough that those concerns should be brought to the attention of regulatory bodies or if the concerns are not at that level then by peer pressure you will have to work with them to improve care.

There should be mechanisms in the PCT to give advice and support via discussions with the medical director who may well be aware of the issues. The current QOF points for QP 7-11 make it necessary to work with other practices to review referrals and look at reasons for variation and then for the practice (not the group) to propose areas for commissioning and service redesign to the PCT. The points will be dependant of actions of the practice. Will peer pressure improve performance ? Only time will tell.

Dr Gary Calver is a GP in Folkestone and member of the GPC's commissioning and service development subcommittee

Reviewing outpatient referrals