Page last updated at 06:52 GMT, Monday, 20 October 2008 07:52 UK

GP referral bonuses 'ridiculous'

John Radcliffe Hospital
The number of patients referred to the John Radcliffe Hospital is up

A scheme that pays bonuses to GPs for not referring patients to hospital has branded "absolutely ridiculous" by a patient group.

Oxfordshire Primary Care Trust (PCT) has introduced a policy which means doctors' surgeries can be rewarded for reviewing and reducing referral rates.

An average sized practice can earn up to £20,000 extra per year.

The Nuffield Orthopaedic Centre's Patient Support Group said the scheme would be detrimental to patients.

If doctors hit their targets, Oxfordshire PCT would pay out £1.2m, but it said that was justified because increasing hospital referrals were costing the trust £6m.

The number of patients referred to Oxford Radcliffe Hospital NHS Trust and Nuffield Orthopaedic Centre NHS Trust is up by 8%.

The payment is for the time it takes to do the review and a bonus if they manage to bring the referral rates down
Oxfordshire PCT spokeswoman

Surgeries with 10,000 patients will get £10,000 to review referral procedures, and up to £10,000 more for reducing rates.

Sue Woollacott, chairman of the Nuffield patient support group, said: "I think it's absolutely ridiculous.

"It seems to imply that GPs aren't presently making good judgements and need financial incentives in order to do that.

"To delay patients, who are often elderly, who need good orthopaedic care, and to delay them from getting necessary care can often complicate the procedures that they then eventually have to have."


Dr Laurence Buckman, chairman of the British Medical Association's GP Committee, said: "I don't think that patients' services should be treated as a commodity which is incentivised if you don't do something.

"A large number of patients are referred to hospital for investigation. If you don't know what's wrong with the patient you cannot know how to handle the problem."

Shadow Health Secretary Andrew Lansley said: "It is inefficient and unethical to pay GPs to refer fewer patients to hospital.

"It would be so much better if GPs, not bureaucrats, had responsibility for their patientsí budgets.

"It is GPs who should be making the decisions about the best use of resources and how best to meet the needs of their patients.

"If patients find out that their local health bureaucracy is paying their GP not to refer them to hospital they will be rightly outraged."

A spokeswoman for Oxfordshire PCT said: "We have significantly increasing rates of referral into secondary care providers. We're trying to understand why.

"The payment is for the time it takes to do the review and a bonus if they manage to bring the referral rates down."

A spokesman for the Department of Health said parts of the country had experienced a big increase in referrals to hospital by GPs.

"It is quite right for the local Primary Care Trusts affected to examine GP referral patterns in their area.

"Most people prefer to be treated at home or in the community rather than in hospital if possible. GPs should base their referral decisions on what is clinically appropriate."

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