'Get the story right!

GPs do NOT personally gain from reducing referral rates to secondary care. Any money saved (NOT achieved by stopping patients who need to see a see a specialist from seeing him/her but by reducing unnecessary follow ups) can be used to improve patient care eg by purchasing physiotherapy services so patients can be seen more rapidly. The purchasing process is rigorously controlled by the PCT.'


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And just in case some people can't open the link, here is what's inside it:

Doctors paid thousands not to send patients to hospital for treatment
Family doctors are being paid thousands of pounds not to send their patients to hospital for specialist treatment, sparking fears over standards of care.

>>>>>By Patrick Sawer and Laura Donnelly
Published: 3:40PM BST 18 Oct 2008

Dozens of incentive schemes have been uncovered which allow GPs to profit by slashing the number of patients they refer for hospital care.

Under one scheme, GPs stand to gain £59 for every patient not referred to hospital, if they cut an average referral rate by between two and eight per cent.


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NHS managers say referral rates, which rose 16 per cent nationwide during the first quarter of this year, have to be cut to save money. They claim many patients can receive equally good care from community NHS staff, such as physiotherapists and nurses.

But critics fear that patients could suffer if GPs' decisions are swayed by the prospect of a cash bonus.

A leading surgeon said that patients' cancers had already gone undiagnosed after they were denied specialist care under two such "referral management" schemes.

Orthopaedic surgeon Stephen Cannon, former president of the British Orthopaedic Association and a consultant surgeon at the Royal National Orthopaedic Hospital, described the cases as an "absolutely terrible" warning that decisions by non-specialist doctors could have devastating consequences.

He said: "I recently encountered two cases in which patients referred to physiotherapists later turned out to have a malignant tumour. If they had been sent to a consultant the outcome may have been very different.

"In one case a young man was referred to a physiotherapist because of sudden knee pain. Had he come to a specialist the symptoms should have been recognised and he should have been urgently referred to an oncologist. In this case, after the delays, the outcome was amputation. It was devastating for the patient and his family."

Dozens of practices across London, Essex, Oxfordshire, Devon and Wiltshire have signed up for schemes which pay GPs up to £4.50 for every patient on their list if they hit targets, including a target to reduce the proportion of patients they send to hospital.

The average family doctor, with a patient list of about 2,000 patients, stands to make between £6,000 and £9,000 if they achieve all the targets, on top of a performance-related pay system which already gives the average GP an income of £110,000.

Under the schemes, GPs will also be paid to spend time discussing patient cases with colleagues in the hope this will result in fewer referrals to hospital and more patients being treated by physiotherapists, community nurses and non-specialist staff.

Oxfordshire primary care trust will pay its GPs an extra £1 for every patient on their list for time spent discussing case details with colleagues, and a further £1 per patient on their list if they cut the number of referrals by an average of four per week. For the average practice, with an average referral rate, that could mean as much as an extra £12,000 income.

Since the scheme was introduced at the start of this month, 80 of the county's 82 GP practices have signed up. Dan Lasserson, a GP at Oxford's Jericho Health Centre, attacked the scheme, saying "There should not be a personal financial incentive put in front of anybody when deciding about delivering patient care. It will take the focus off the patient and erode patient trust."

Dr Lasserson is refusing to take part in the plans.

"It's OK to say that GPs should discuss cases to see if there's an alternative to hospital for a particular patient. But that should be happening anyway," he added. "What I strongly object to is setting targets which are linked to payments.

"Patients need to know that decisions about their future are not been weighted by financial discussions."

Sue Woollcott, chair of the Patient Support Group at Oxford's Nuffield Orthopaedic Centre, said: "There's a possibility that GPs will end up basing decisions not on clinical need but on their budget."

Specialist doctors fear serious health conditions could go undetected and allowed to worsen.

Dr Chris Deighton, of the British Society for Rheumatology, said delays in receiving specialist care could allow patients to deteriorate and even cause permanent harm.

"If someone develops rheumatoid arthritis, time is of the essence," he said. "There is a window of opportunity when intervention from a specialist and a whole team can make a real difference."

Dr Deighton cited research showing that delays diagnosing arthritis increase the risk of the condition becoming so severe that patients are unable to work, adding: "In particular I worry about the mild onset cases, which often have a worse prognosis in the long run but are less likely to be detected by non-specialists. GPs are not in a position to judge."

Dr Alistair Moulds, a GP from Laindon, Essex, has refused to sign up to a South Essex scheme which pays the average GP practice £9,000 to hit targets to reduce pressure on hospitals.

He said: "Paying GPs to try to keep patients, especially emergency admissions, out of hospital could be dangerous to patient care and safety. I don't think most GPs would not send someone to hospital in order to make fifty pounds, but I don't think that financial incentive should be there at the point a doctor is making a critical decision."

Twenty-four practices have already signed up to the Essex scheme, which began in August, while all 62 practices in Wiltshire have agreed targets which could boost average GP income by £6,400.

In Hampshire, the average GP practice will get £4,000 if they can stem rising numbers of referrals. The PCT will pay its 148 practices a maximum of £4,000 each if their referrals increase by less than five per cent. The PCT is also paying £200 a week for staff cover so GPs can spend more time discussing whether a patient should be referred to hospital or treated in the community.

Health chiefs have defended the payments, saying they are a way of encouraging GPs to spend a bit longer weighing up the pros and cons of referring patients and exploring whether there are any alternatives to hospitalising people who would frequently prefer to remain at home.

Helen Clanchy, director of primary care for Hampshire PCT, said: "The scheme is about getting GPs to understand they have got a number of alternatives to referral. Primary care has many experienced doctors, trained to consultant level, who are in a position to spot symptoms that need referral or immediate hospitalisation."

Alan Webb, director of commissioning for Oxfordshire PCT, said: "We hope to see fewer referrals, but we are not paying GPs not to refer patients. Any patient in Oxfordshire who needs a hospital referral will get one."

Dr Phil Green, for Torbay care trust, said its scheme was designed to "promote effective use of care service" and help GP practices "review and reflect on" the patients they refer to hospital.

Richard Hoey, from Pulse, a magazine for GPs, said the schemes were provoking controversy among family doctors.

He said: "The fear is that these schemes are attempting to artificially reduce referrals, rather than address the problems leading to them."

Shadow Health Secretary Andrew Lansley added: "It is inefficient and unethical to pay GPs to refer fewer patients to hospital.

"If patients find out that their local health bureaucracy is paying their doctor not to refer them to hospital they will be rightly outraged."

HOW THE INCENTIVE SCHEMES WORK

OXFORDSHIRE

GPs will receive an extra £1 for every patient on their list to pay for time to discuss patient cases with colleagues to see if there is an alternative to hospital referral. They will be paid a further £1 per patient on their list if they cut the number of referrals by an average of four per week. For a practice with 6,000 patients and an average referral rate that could mean an extra income of £12,000.

HAMPSHIRE

The county's 148 GP practices will be paid extra to keep the increase in their referral rate to below a certain level. Those practices who keep the increase to five per cent and below will receive the full amount, £4,000 for the average practice. GP practices will also be paid an average £200 a week over a 12-week period for extra staff cover to allow doctors to spend more time discussing patient cases with colleagues in a bid to find alternatives to hospital treatment.

TORBAY, DEVON


All Torbay's 22 practices have signed up to a scheme under which a GP with an average referral rate can gain £59 for every patient not referred to hospital, up to a maximum eight per cent reduction in referrals. Torbay care trust will pay up to £15,000 to the average GP practice if it hits a series of targets including those to reduce hospital referrals, spend less than its budget, and have fewer of its patients admitted to hospital in an emergency. <<<<<