Five CCGs give GPs cash incentives to slash hospital referrals in a bid to ease pressure from secondary care, an investigation has found.
Five CCGs give GPs cash incentives to slash hospital referrals in a bid to ease pressure from secondary care, an investigation has found.
A Freedom of Information (FOI) request sent to 181 CCGs by our sister publication Pulse found that Pulse found that eleven CCGs were offering direct incentives based on GPs changing their referral behaviour.
Five of these CCGs offer 'profit share' arrangements, giving practices a cut – up to 50% in some cases – of the savings generated to encourage them to avoid referring patients to hospital.
Healthcare Leader has contacted the five CCGs in question for comment. Read their responses to Pulse here.
Read the responses given to Healthcare Leader by NHS Coastal West Sussex CCG here and NHS Enfield CCG here.
The five CCGs offering ‘profit sharing’ schemes are:
• NHS Coastal West Sussex CCG is offering groups of GP practices 50% of the savings on any reduction in elective activity from the previous year;
• In West Leicestershire, GP federations receive 30% of savings made on first elective referrals;
• NHS Vale of York CCG offers GP practices a ‘gain/share’ arrangement for dermatology referrals and ‘a proportion of any savings achieved’;
• NHS Enfield CCG in north London says 50% of any cost reduction for GP-referred outpatient attendance ‘will be shared with the locality’;
• NHS Wolverhampton CCG says it is considering a profit-sharing scheme.
Dr Peter Swinyard, chair of the Family Doctor Association said: ‘From a patient perspective, it means GPs are paid to not look after them. It’s a serious dereliction of duty, influenced by CCGs trying to balance their books.’
Other CCGs were offering payments for big reductions in elective referrals, including a £1.4m scheme that sees practices paid £5 per patient for cutting GP referrals by at least 10%, Pulse has found.
Commenting on the findings, chair of the Royal College of General Practitioners (RCGP) professor Helen Stokes-Lampard said: ‘It's high time for commissioners to appreciate that GPs are highly-trained medical professionals, who know our patients, and will act in the best interests of their health and wellbeing.
‘We are well aware of the financial strains currently facing the NHS but GPs will only ever make the decision to refer a patient to secondary care on the basis of a consultation with that patient, taking into account their individual circumstances, and if we consider it necessary to achieve the best health outcome for them.’
GPs should receive more support when deciding to refer patients to secondary care, the RCGP said in a report published earlier this week.
CCGs can look into alternative ways to take the pressure off secondary care. A case study published by Healthcare Leader last month showed how a CCG managed to reduce A&E attendances by increasing the number of referrals from London Ambulance Service (LAS) to Rapid Response Teams (RRTs).
'Clinically appropriate referrals' assured
An NHS Enfield CCG spokesperson said:‘NHS Enfield CCG uses a referral incentive scheme to ensure all referrals from primary care to secondary care are quality assured and clinically appropriate.
‘GP practices are required to reinvest savings in areas to directly support improvements in patient care and patient experience. All proposals for reinvestment are reviewed and approved by the CCG.’
Patients referred when necessary
Dr Jeremy Mayhew, clinical lead for primary care at NHS Coastal West Sussex CCG, said: ‘We know that historically people have been referred without the right information or have been directed to a service that isn’t right for the treatment they need.
Last year we made a really positive agreement with the GP practices to support them to work together to make sure that all of the referrals that are made in Coastal West Sussex go to the right service with the right information when a person needs a particular treatment or type of support.
It is important to be clear, any patient who needs a referral absolutely will be referred for the treatment and support they need – and there is no restriction on the number of referrals a GP practice can make.
The agreement focuses on reducing the number of inappropriate or incomplete referrals, when a patient can be waiting several months only to be bounced back to their GP practice – causing a delay in care for that patient and a cost to the NHS system.
Inappropriate referrals, even those that bounce back to the GP practice without a patient receiving any further treatment or support, cost the NHS money.
To encourage GP practices to take the time to review their referrals and share this learning, money saved within the system is being reinvested in improving patient care.
After approval by the CCG, funding is available for schemes led by practice groups to improve access to primary care services and the development of local community services; no GPs receive payment, directly or indirectly.
To date this agreement has helped to fund extra appointments over winter, new clinics for minor injuries, and to place clinical pharmacists in GP practices to help with medicine reviews and treat patients directly.’
