GPs are being offered cash incentives worth up to £200,000 for NOT sending their patients to hospital for routine operations such as hip and knee replacements and cataract treatments
The doctors are being told to slash the numbers of referrals for procedures of ‘low clinical value’
The Mail Online reports:
Doctors are also urged to avoid sending patients in for outpatients appointments before or after operations as these are deemed to be a waste of time.
The controversial scheme has been introduced by managers in the North West to save money on the basis that this will improve care and free-up more appointment time.
But it has concerned a number of GPs, who say it may ‘colour the judgement’ of some of their colleagues.
They are worried that doctors will be inclined not to refer patients for important appointments or procedures just because they will earn more money.
A spokesman for the British Medical Association, the professional body which represents doctors said: ‘Clinical Commissioning Groups should not be setting up incentive schemes that force doctors to make clinical decisions based on finances rather than a patient’s health needs.
‘GPs will be appalled by this measure, not least as it will undermine the public’s confidence in the NHS.
‘The crisis facing general practice needs addressing as the service is struggling to cope with unprecedented pressure from rising patient demand, falling resources and staff shortages.
‘But perverse and counterproductive incentive schemes are not the answer.’
The scheme has been rolled out in Bolton Clinical Commissioning Group, a local NHS trust covering 50 surgeries and 270,000 patients.
It was inspired by very similar initiatives already in place in CCGs in Liverpool and Manchester, where doctors are also offered money to reduce ‘unnecessary’ referrals.
But one unnamed GP who practices in Bolton said the policy was ‘unhealthy’ and breached the doctors’ code of conduct, which states that patient care must come first.
‘The CCG is incentivising doctors not to refer and that is an unhealthy development.
‘Many of my colleagues in Bolton are expressing disquiet about this and the Bolton Local Medical Committee (a group of GPs) feels it falls short of General Medical Council guidelines.
‘Patients need to realise there is cash coming between their doctor and their referral. This cannot help but colour the judgement of GPs.
‘Practices with higher referrals have been told to bring these down in line with averages as there are some quite large discrepancies, but this can reflect the surgery’s demographic.’
Under the scheme, surgeries will be paid a share of £96,000 if they successfully reduce the numbers of patients referred to procedures of ‘low clinical value’.
These include hip and knee replacements, cataract treatment, and operations to treat hernias, varicose veins and gallstones, which aren’t considered urgent.
They will be paid a further £46,000 for cutting down on the numbers of patients attending outpatient follow-up appointments – considered unnecessary – and another £46,000 for slashing outpatient first consultations.
The money will be given directly to the surgery for doctors to decide exactly how it is spent.
The incentives are part of a £3.4 million scheme called the Bolton Quality Contract which is aimed at saving money, improving care and freeing-up GPs’ time so they can carry out an estimated 61,000 appointments in total each year.