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GPs to be offered ‘perverse’ incentive for reducing emergency admissions by 10%

Exclusive GPs in one area are being incentivised to achieve a 10% reduction in emergency admissions this winter, which the GPC warns was a ‘potentially dangerous’ scheme that could ‘undermine the patient-doctor relationship’, Pulse can reveal.

The ambitious scheme has been rolled out by NHS Doncaster CCG in response to pressure to reduce hospital admissions, and will give practices the chance to earn up to £2 a patient.

The local LMC said it recognised it as a ‘perverse incentive’ for GPs but was ‘trying to be positive’ about the potential to access the extra funding.

This is the latest CCG scheme to link payments to emergency admissions, after a Pulse investigation found that NHS West Suffolk CCG and NHS Ipswich and East Suffolk CCG are linking funding worth £5 per patient to outcomes.

NHS England’s ‘cash for diagnoses’ dementia scheme has similarly been criticised for putting GPs in a difficult position as their clinical decisions are viewed by patients as being influenced by financial interests.

Under the NHS Doncaster CCG scheme, local GP practices managing to achieve a 2% reduction in unplanned admissions in January to March 2015 compared with the same period in 2014 will receive 40p per patient.

They will receive a 40p-per-patient incremental increase for every 2% further reduction up to £2 a patient for those reducing admissions by 10%.

Doncaster LMC chair Dr Dean Eggitt said: ‘On the negative side, there is now a perverse financial incentive to drive down unplanned admissions. That is the problem with the direction of travel for commissioning at the moment, that everyone wants to do outcomes-based commissioning.’

However, he added that he ‘tried to be quite positive’ about the initiative to reduce unplanned admissions.

He said: ‘From our CCG’s perspective I actually see it as a very welcome step really; that they’ve tried to invest more money in primary care, for a good reason. I just hope that GPs remain quite clear about what their job is, rather than chasing the finance.

‘Hopefully we will have done enough work to have affected unplanned admissions over the winter period.’

But GPC deputy chair Dr Richard Vautrey said this was the type of scheme that the GPC has ‘fought against’ being rolled out on a national level in the past because of their risk to GPs.

He said: ‘We would not support such schemes and successfully fought against a similar scheme being implemented nationally in the past.

‘As with the dementia enhanced service these simplistic but potentially dangerous schemes could mean patients doubt the judgement or motives of their GPs when a referral is not made as they expected or wanted and they undermine the doctor-patient relationship as a result.’

A spokesperson for NHS Doncaster CCG said: ‘This winter we are proposing to commission for improved outcomes by rewarding primary care teams for providing good quality care.

‘The scheme is focused on rewarding practices for providing high quality primary care to the most vulnerable people in our community. The CCG operates from a position of trust with our GP colleagues and believe they will exercise sound clinical judgement in all circumstances. If this was found to not be the case with any individual we would address the issue through the appropriate route.’


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