GPs paid not to refer patients

October 20, 2008 2:34 PM

This, from the Times, appears to be yet another example of clumsy public sector targets.  There should be a balance between keeping unnecessary referrals to a minimum and making sure that referrals are made when they are worthwhile.  The PCTs don't have any direct incentive to provide the service patients want, though, so they will focus purely on keeping down unnecessary referrals to ease pressure on their budgets and may hurt standards of care as a result:

"GPs are paid £1 per patient to spend time reviewing their decision to send someone to hospital and a further £1 for every name on their surgeries’ list if they reduce their previous year’s referral rate. An average surgery with 10,000 patients will receive up to £20,000 for taking part in the scheme.


Eighty out of 82 practices in the Oxfordshire Primary Care Trust area signed up for it this month. Similar incentive schemes have been set up across the country despite the NHS’s National Institute for Health Research (NIHR) giving a warning about the risks. “Financial incentives to encourage GPs to reduce referral rates can be effective, but this is a high risk,” it says. It concludes that reduction “may apply to both necessary and unnecessary referrals”.


[...]


“If [the payment] triggers some sort of thoughtful process, such as talking to a more experienced colleague, then that is commendable and may save unnecessary referrals,” said Professor Roland, director of the National Primary Care Research and Development Centre. “But I would be cautious about incentives simply to reduce numbers if they are not tied to some sort of clinical review. The danger is that patients who would benefit from referral to hospital would no longer be referred.”

This, from the Times, appears to be yet another example of clumsy public sector targets.  There should be a balance between keeping unnecessary referrals to a minimum and making sure that referrals are made when they are worthwhile.  The PCTs don't have any direct incentive to provide the service patients want, though, so they will focus purely on keeping down unnecessary referrals to ease pressure on their budgets and may hurt standards of care as a result:

"GPs are paid £1 per patient to spend time reviewing their decision to send someone to hospital and a further £1 for every name on their surgeries’ list if they reduce their previous year’s referral rate. An average surgery with 10,000 patients will receive up to £20,000 for taking part in the scheme.


Eighty out of 82 practices in the Oxfordshire Primary Care Trust area signed up for it this month. Similar incentive schemes have been set up across the country despite the NHS’s National Institute for Health Research (NIHR) giving a warning about the risks. “Financial incentives to encourage GPs to reduce referral rates can be effective, but this is a high risk,” it says. It concludes that reduction “may apply to both necessary and unnecessary referrals”.


[...]


“If [the payment] triggers some sort of thoughtful process, such as talking to a more experienced colleague, then that is commendable and may save unnecessary referrals,” said Professor Roland, director of the National Primary Care Research and Development Centre. “But I would be cautious about incentives simply to reduce numbers if they are not tied to some sort of clinical review. The danger is that patients who would benefit from referral to hospital would no longer be referred.”

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