Bad practice

Several tragic stories recently have shown the importance of GPS both diagnosing patients correctly and referring them to specialists when they are unsure. Yet an investigation by the magazine has found that family doctors in parts of England are being offered financial incentives to keep patients away from hospitals.

People will find it hard to understand how such schemes have come into being. GPS are the gatekeepers to the rest of the NHS and if they are encouraged to keep the door shut then people who may need further treatment will be endangered.

The Royal College of GPS and the Family Doctors Association say this is a consequence of the primary care commissioning bodies trying to balance the books at a time of budget cuts. It means that GPS are being paid not to look after their patients, which is clearly unacceptable.

There is a problem with the scale of referrals. In 2008-09, the last year that figures on the number of general practice consultations were collected, around one in 20 GP consultations resulted in a referral to secondary care. Even if the rate has not changed much, the number of referrals is much higher today because of the far greater activity in the NHS.

Referral management schemes have been put in place to reduce pressure on secondary care. But like many innovations in the NHS, they risk turning into tick-box exercises intended to achieve an arbitrary target rather than something that will improve patient outcomes and boost efficiency.

There is nothing wrong with trying to avoid unnecessary visits to hospital, but offering a substantial financial incentive to limit referrals is a dangerous approach.