Doctors are to be offered cash ‘bribes’ to slash the number of patients they send to hospital.GPs have been promised financial incentives of up to £26,000 for their surgery if they take certain measures to reduce referrals.
Every time a doctor sends a patient to hospital for a scan, consultation or operation, the local NHS trust is charged for the cost of their treatment.Controversial: Doctors are to be offered cash 'bribes' to slash the number of patients they send to hospital.
The trusts are trying to save money by urging GPs to cut the numbers of so-called ‘inappropriate’ referrals.But leading doctors, including members of the British Medical Association, say it is ‘unethical’ to pay doctors for effectively withholding treatment.
Dr Laurence Buckman, chairman of the GP committee at the British Medical Association, said: ‘There is no way that paying doctors for withdrawing treatment is acceptable.
‘It produces obvious conflicts of interest. You cannot ever have the patient in front of you think that it’s in your interests not to treat them.
‘It’s not just me that thinks this – I’ve yet to find someone who thinks it’s a good idea. I don’t sense overall enthusiasm.‘I’m very concerned that these schemes are happening.’Fears: Dr Laurence Buckman, chairman of the GP committee at the British Medical Association, said it is not acceptable to pay doctors for withdrawing treatmentUnder a scheme proposed by Harrow Primary Care Trust, in North West London, doctors have been promised up to £4 for every patient in their practice if they follow certain steps aimed at cutting referrals.
The amount of money each practice gets depends on the number of patients on its books and whether it meets all of the ‘referral’ targets that are set by the PCT.To get the full amount, practices must follow a number of steps, which include reducing their referrals by up to 10 per cent.
They must draw up lists giving details of the name of the patient referred, the reason they were sent to hospital and the GP who ordered it.
The practice must also nominate a GP to scrutinise every patient referral to hospital, to ensure they are ‘appropriate’. The scheme covers all referrals, ranging from patients sent for scans to rule out possible cancer to those needing to see a specialist for a hip or knee replacement.If a practice meets all the criteria it will get £4 for every patient on its books. If it only fulfils some, it may get just £1 or £2 per patient.An average-sized practice with 6,500 patients stands to earn a maximum of £26,000 extra, provided it meets all the targets.Doctors could then decide to spend the money as they wished, on better facilities for the surgery or to increase their salaries, for example.The number of referrals varies hugely between practices depending on whether the local NHS trust has policies to try to limit them, patients’ average age, and their illnesses.
But a surgery with 6,500 patients is likely to send between 650 and 1,300 to hospital a year.A spokesman for Harrow PCT said the proposals were still ‘under discussion’ and had not yet been implemented.The PCT also insisted the scheme was meant to be in patients’ ‘best interests’ and that they were trying to improve care while making the best use of NHS money.
Other trusts and clinical commissioning groups – organisations of GPs, which will in future be responsible for designing local health services – are also offering money to practices that cut referrals, although the rewards are not as high.Changes: GPs have been promised financial incentives of up to £26,000 for their surgery if they take certain measures to reduce referrals. This picture is posed by a modelAt Hardwick Clinical Commissioning Group, in Derbyshire, practices are offered 25p per patient, up to around £1,600 in total, if they cut referrals.Luton PCT, in Bedfordshire, is also proposing to offer practices extra funding to cut referrals, though the details are still being drawn up.
A spokesman for Harrow PCT said: ‘This proposed scheme is about improving the clinical quality of referrals in the patient’s best interest.
‘The scheme is explicit in stating that patients must be referred where clinically appropriate at all times and that the process will ensure the best and most rapid treatment for that patient.’
Although the NHS has been protected from cuts to its budget, it has been ordered to make £20billion of savings by 2014 by running more efficiently.Whitehall officials say the savings are necessary to ensure there is enough money to care for the increasing elderly population.But in the face of such stringent targets, many NHS trusts have resorted to trying to slash referrals, rationing certain treatments and cutting back on the number of staff.Some trusts are trying to reduce spending by sending patients to other surgeries or clinics which offer scans or specialist services such as physiotherapy, rather than sending them to hospital, because it is cheaper.