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GPs should not be rewarded for cutting referral rates, says BMA

4 February 2009

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GPs should not take part in referral management schemes that offer GP practices financial rewards for cutting patient referrals, the British Medical Association (BMA) said today (Wednesday 4 February 2009).

In a new document, the BMA’s GPs Committee (GPC) offers practices in England guidance on referral demand management and analysis schemes. These initiatives are designed primarily to help GP practices examine the way they refer patients to other services, such as hospitals.

Referral schemes have developed in response to rising patient referral rates. More recently, variations have emerged that offer GPs financial rewards for cutting referral rates to pre-agreed levels set in co-operation with local health bodies.

The main conclusions from the guidance are:

  • “When developed in partnership with doctors, referral management schemes can provide benefits to patients by allowing GPs to discuss nonurgent cases with their colleagues. This can result in patients being offered an alternative course of treatment and GP practices identifying services they can develop for the benefit of their patients. As practices would incur extra costs by taking part in these schemes, it is acceptable for them to receive some extra funding.”
  • “It is not acceptable for practices/groups of practices to receive funding or payments for schemes that provide specific financial rewards for reducing referral numbers or costs to certain levels or by certain amounts. These types of target-based schemes could result in a perverse incentive to reduce referrals.”

Dr Laurence Buckman, Chairman of the GPC (pictured), said: “Properly run referral schemes can improve patient care. They have the potential to reduce the pressure on local hospitals, provide patients with a greater say over their care and help them obtain treatment in their local community. They also give GPs an idea of what services they might want to develop ‘inhouse’ at their practice.

“However, it is not acceptable for these schemes to provide specific financial rewards to GP practices which reduce patient referrals to pre-agreed levels or by certain amounts. This doesn’t help anyone – patients, local services or the wider NHS.

“We understand that in some areas of the country referral rates are rising, putting extra financial pressure on the NHS. But health managers must not seek to tackle this problem by setting up target-based referral schemes. All referrals must be driven solely by what is in the best interests of the patient.”


Do you agree with the GPC? Your comments (terms and conditions apply):

“It is a question of focusing minds. We have been part of such a scheme and we believe it has improved patient care. All of the referral letters that leave the practice are now read and reviewed by a different doctor than the referring doctor, before they leave the practice. Different care pathways have been identified in some cases and it has really made the GPs think very hard about their referrals. We were not a high referring practice before the scheme but enbraced it as a learning experience, which is the spirit in which it has been undertaken. To suggest that any patient who genuinely needs to be referred would not be is misguided. It just enables cross-fertilisation of ideas, more discussion about patient care, and looking at appropriate alternative care pathways” – Janet Newman, Oxfordshire

“Yes. The practices being rewarded for such are clearly not the practices working the hardest. Also it will damage doctor/patient relationships if the patients thought the GP was not referring them to specialist care due to monetary gains!” – Julie Swaffer, St Leonards on Sea

“Yes, to a point. Some GPs refer far more than their colleagues. PCTs need to look at referral rates and point out to those GPs who far exceed the average that they need training and support. It should be reflected in their appraisals” – Patrick Jordan, Cheshire