GPs are being offered cash payments not to refer patients to hospital, in a move which leading family doctors have criticised as ethically questionable and a risk to health.
NHS bodies in four parts of England are using schemes under which GP practices are given up to half of the money saved by sending fewer patients to hospital for tests and treatment
The disclosure by the GP website Pulse about the controversial “profit share” initiatives operated by the four NHS clinical commissioning groups (CCGs) has triggered a row.
Critics said the schemes were the latest example of NHS bodies increasingly resorting to the rationing of care to help them operate within their budgets.
NHS Coastal West Sussex CCG has offered to give groups of practices working together in its area 50% of savings made from GPs referring fewer patients for dermatology care, ear, nose and throat treatment in the community, and minor surgery and wound closure.
Helen Stokes-Lampard, chair of the Royal College of GPs, said: “Cash incentives based on how many referrals GPs make have no place in the NHS, and frankly it is insulting to suggest otherwise.” Family doctors did need help to ensure they were refer the right patients but that should not involve “ethically questionable initiatives that prioritise cash savings over patient care”, she said.
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.”
England’s 207 CCGs hold the budget for the NHS locally and decide which services are provided for patients. NHS West Leicestershire, which is offering federations of GP surgeries 30% of savings resulting from fewer “first referrals”, said the scheme was designed to cut the number of “clinically unwarranted and unnecessary referrals, particularly into secondary care” and would let hospitals treat the most needy cases.