Cash for GPs to keep people out of hospitals!

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Junior doctors had a very good idea about the kind of NHS that health secretary Hunt and the Tories were creating – one whose main objective was to keep as many patients as possible out of hospital
Junior doctors had a very good idea about the kind of NHS that health secretary Hunt and the Tories were creating – one whose main objective was to keep as many patients as possible out of hospital

A LEAKED memo has exposed a plan to slash the amount of patients referred by GPs to hospitals by 30%!

After seeing the memo, Dr Andrew Green, BMA GP prescribing subcommittee chair, said: ‘GPs are used to seeing un-referenced claims such as “could reduce by up to” in adverts for antiwrinkle cream and I am surprised to see such language in an official document.’

The alarming leaked memo shows that Clinical Commissioning Groups (CCGs) will be given extra money if they implement a system aimed at reducing the amount of patients referred from GP surgeries to hospitals by 30%. In other words financial incentives are being offered not to refer patients to hospital.

This latest scheme designed to reduce patient referrals shows that NHS England wants GPs to meet weekly to whittle down the amount of patients they refer. The leak shows that NHS England wrote to CCGs in May, asking them to ensure that there is a ‘clinical peer review of all referrals from general practice by September 2017’, and this should be done ‘on a weekly basis’.

The May 2017 guidance ‘Elective Care High Impact Interventions: Clinical Peer Review’ says that there will be ‘significant additional funding’ for commissioners to establish ‘GP peer review schemes’ this year.

An email from NHS Bedfordshire CCG to commissioners on plans to scrutinise GPs’ referral schemes includes an attachment from NHS England which says that those who implement these schemes will be rewarded with a boost in funding.

The NHS England report says: ‘Significant additional funding is being given to regional teams in 2017/18 to roll out and spread interventions and schemes that will help CCGs to deliver a slower growth in referrals.’

NHS England claim that ‘published literature identifies internal peer review as a positive intervention with benefits to patients and GPs and it could also reduce referral rates by up to 30%’. But Professor Azeem Majeed, professor of primary care and head of the department of primary care and public health at Imperial College London, warned that referral management schemes can sometimes ‘result in delays in referrals’, particularly when assessors are ‘not fully aware of the background to the referral’.

He said: ‘To carry out effectively, clinical peer review requires adequate time and resources.

‘Given the current pressures on NHS general practice in England, this scheme may well end up as a tick-box exercise rather than something that will improve patient outcomes and NHS efficiency.’

Dr Andrew Green added: ‘I wish NHS England put a tenth of the effort they expend on reducing pressure on hospitals into reducing pressure on GPs, which is the area of the health service with the biggest growth in workload.

‘It is important to be aware of the lost-opportunity costs of schemes like this, if we assume an hourly weekly meeting that would be equivalent to removing 1,000 GPs from the English workforce, GPs we don’t have.’

At the beginning of the year, the news broke that private companies were acting as a barrier between GPs and the NHS. Millions of pounds were being spent on privately-run schemes to ‘screen’ and prevent patients from being referred by GPs to specialist services.

In one case referral of a patient to a dermatologist was rejected by the referral management system. It turned out to be a cancer.