Practice-based commissioning may well be working, as early evidence shows that GPs are sending fewer patients to hospital for unnecessary appointments.
Reports from the NHS show that GP practices in some parts of the country are cutting the number of patients they refer to consultants by a quarter by taking direct control of commissioning decisions.
Evidence from early adopters of practice-based commissioning (PBC), the government reform giving primary healthcare professionals the power to redesign services that better meet the needs of their patients, shows that practices have cut patient referrals for hospital treatment by between 25% and 33%.
A 25% reduction in the number of GP referrals, if matched across the entire NHS, could see around 2.5 million patients receiving care in more convenient locations, such as community-based health centres and GP surgeries, rather than traditional large hospitals, every year.
Health Minister Andy Burnham said: “Dealing with some referrals outside of large hospitals is common sense, as it can relieve pressure on the NHS, provide more convenient care for patients, deliver better value for money for the taxpayer, and help us slash hospital waits. Only by working in new ways, such as through practice-based commissioning, will we deliver the target that no-one will wait more than 18 weeks for treatment by 2008.”
Figures for December 2006, show that all 152 PCTs have achieved universal coverage, as per the planned target. The figures also show that 7,849 practices out of 8,433, or over nine out of ten (93%) of all GP practices in England, have taken up an incentive payment to participate in PBC.
Early PBC adopters seeing a reduction in referrals include:
- Kingston Co-operative Initiative – a cooperative set up by all GPs within the London borough is now assessing and managing all patient referrals to hospital. In the first three months of this PBC initiative, GPs in the consortium have cut patient referrals to secondary care by 25%.
- Manchester PCT has set up a GP with special interest-led gynaecology service (GPwSI), which is commissioned by the local PBC consortium to triage all referrals into secondary care. The GPwSI currently handles 32% of referrals, but the service is expected to expand to so that only 30% of current referrals will still be seen in secondary care.
The number of GP referral requests for first outpatient appointments in England is 9.8 million (2005/06). A 25% reduction in GP referrals would see this figure drop to 7.35 million.