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Pulse 2018 review: Cash incentives targeted at GPs who cut referrals



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NHS finance

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In February, Pulse exposed controversial plans to offer GPs cash incentives for cutting back on patient referrals to secondary care.

The ‘Cash for Cuts’ investigation revealed that in some parts of the country, CCGs were offering money in return for referring fewer patients, in a bid to relieve pressure on secondary care in those areas.

Pulse received 181 CCG responses to freedom of information requests as part of the investigation. One quarter said they offered some kind of financial inducement for reducing referrals to specialists.

Eleven CCGs were paying practices that meet specific referral-cutting targets. In other words, some GPs are being incentivised for not referring their patients.

‘Profit share’ arrangements were up for grabs across five CCGs, which offered practices up to 50% of the savings derived when GPs curb referral activity.

Among other highly contentious and ‘unsafe’ incentives was an NHS Barnsley CCG scheme, worth £1.4m, in which practices that slashed referrals to a handful of specialisms by 10% or more were paid £5 per patient.

GP leaders – unsurprisingly – vociferously criticised such schemes.

Dr Peter Swinyard, chair of the Family Doctor Association, echoed the views of colleagues and peers when he called financial incentivisation a ‘serious dereliction of duty’. In a patient’s eyes, ‘it means GPs are paid to not look after them’, he added.

Not only are cash incentives for reducing referrals ethically questionable, but there is no evidence they actually work.

Granted, these schemes may result in fewer unnecessary referrals. But referrals that are needed – patients who really do require specialist consultation or treatment – could well be the collateral damage.

Coinciding with Pulse’s investigation, the RCGP published a review into referral management centres that are set up by CCGs to reduce GP referrals to secondary care.

It stated these centres were not demonstrably safe or cost-effective, undermine GPs, and erode patient trust – and called for them to be scrapped.

But despite the outcry back in February, come autumn most of the CCGs offering profit share schemes in return for fewer hospital referrals looked set to move forward with their plans.

By September, only one of the five had done a U-turn. Three are going ahead in the 2018-19 financial year, while one CCG was still reviewing arrangements.

And while cash for referral cuts may ease some strain on hospital services, the consequence for GPs is yet more stress, which they could well do without.