Concern over GP referral bonuses

The number of hospital referrals has been increasing

Paying GPs to cut hospital referral rates could damage confidence in the service, key health staff say.

Health bosses in England have started introducing incentive schemes to get doctors to reduce referrals as the NHS tries to achieve hit waiting targets.

The NHS Alliance, which represents GPs and community staff, said the payments were not wrong, but were a grey area.

The group said guidance was needed to counter accusations doctors may not be acting in the patients' best interests.

Last week Oxfordshire Primary Care Trust hit the headlines after offering payments to family doctors to help cut the 8% rise in referrals to its local hospitals.

Doctors should not give the appearance of acting in a way that isn't in the patient's best interests Dr David Jenner, of the NHS Alliance

Under the scheme, an average practice could earn up to £20,000 a year extra.

Other PCTs, which pay for local health services, are thought to be considering similar schemes as part of the drive to ensure the NHS hits its waiting time target.

By the end of the year, all patients should be treated in hospital within 18 weeks.

But one of the consequences of the falling waits has been a surge in referrals.

Waiting

The NHS Confederation has estimated numbers have gone up by 15% in recent months, which has partly been attributed to people shunning private treatment because of the short waiting times.

Dr David Jenner, of the NHS Alliance, 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 schemes seem to be in a grey area that has never been considered before."

He added that the only way to stop suspicions was to issue professional guidance on the subject.

The Department of Health said it was writing to regional health bosses working for the 10 strategic health bosses asking them to review what was happening.

A spokesman said: "The issue for PCTs and local GPs is to ensure that any local incentive schemes ensure the best clinical care for patients and are consistent with the General Medical Council rules."