I think that it is acceptable for CCGs to look at the processes behind referrals, and reward practices for focusing on that, like using peer review or using the right local pathways, such as a local GPSI clinic, and not the actual numbers.
Where the problems come in is if you looked at it purely as ‘we can’t refer this patient because we’ll exceed our target in a particular area’.
The CCG has made changes this year that look at overall referral numbers, which is better than focusing on an area such as ENT.
But emergency referrals and referrals for diagnostic tests are still included in the targets, as are two-week wait referrals. This is counter to other initiatives that encourage GPs to refer earlier for suspected cancer.
Our scheme does present us with a conflict of interest. As a practice we’ve managed that by focusing on the process by doing weekly peer reviews of all the routine referrals, instead of focusing on the referrals target.
If you explain that to patients in the right way, by saying ‘I’m going to review your case with my colleagues and determine what is the best pathway for you, and the best care’, then most patients see that as quite positive, less experienced GPs get the benefit of the combined experience of all the clinical team, and we maximise the use of local pathways.
Dr Emma Rowley-Conwy is a GP in Lambeth, London