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General Medical Council urged to rule on referral incentives

27 October 2008

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The General Medical Council (GMC) should issue guidance on PCT incentive schemes that reward GPs who cut referrals to hospitals, says the NHS Alliance.

The primary care body says that, in the absence of professional guidance, both GPs and PCT medical directors could stand accused of breaking GMC rules if a patient came to harm following a decision not to refer, even if that decision was in line with good practice.

The Alliance claims that GMC guidance on what is and is not acceptable is “the only way” to ensure the interests of patients are seen to come first, and that doctors and PCTs are protected from accusations of bad practice or harming patients.

Furthermore, the NHS Alliance said it is good practice for clinicians and PCTs to look at referrals, which can lead to better services for patients. It affirmed that there has been no suggestion that any PCT is encouraging doctors not to refer when it is clinically appropriate to do so.

According to the Alliance, each first referral to hospital costs the NHS between £100 and £200 per patient, depending on the specialty. That compares with around £25 for a GP consultation.

Dr David Jenner, an NHS Alliance national executive member and a GP in Devon, said: “We don’t believe that doctors’ decisions to refer are being influenced by incentive payments. That would clearly be wrong and in breach of the rules.

“However, the rules aren’t just about accepting inducements. Doctors should not give the appearance of acting in a way that isn’t in the patient’s best interests. These new [incentive] schemes seem to be in a grey area that has never been considered before.

“It is only the GMC who can issue professional guidance and they should do so immediately – not only for the sake of patients and their GPs, but also for PCT medical directors who could be accused of offering inducements.”

NHS Alliance

Should the GMC issue guidance on referral incentives? Your comments: (Terms and conditions apply)

“Yes. It is about time the rationing of health services was more transparent” – Name and address withheld