Doctors' surgeries getting cash rewards for NOT sending patients to hospital

The payments for reducing referrals do not include two-week cancer referrals — but do include orthopaedic conditions, cataracts, dermatology and general surgery.

The cash rewards are part of Bolton NHS Clinical Commissioning Group's 'Bolton Quality Contract' — aimed at creating 61,000 more GP appointments a year.

One GP, who asked not to be named, called the practice "unhealthy" and said other doctors in Bolton were also concerned.

He added: "Giving doctors financial incentives not to refer is not in the interests of patients or services.

"Practices with higher referrals have been told to bring these down in line with averages as there are some quite large discrepancies, but this can reflect the surgery’s demographic.

“The CCG is incentivising doctors not to refer and that is an unhealthy development.

“Many of my colleagues in Bolton are expressing disquiet about this and the Bolton Local Medical Committee feels it falls short of General Medical Council guidelines.

“Patients need to realise there is cash coming between their doctor and their referral. This cannot help but colour the judgement of GPs.”

The GP said doctors most commonly make referrals for orthopaedic conditions, cataracts, dermatology and general surgery.

The quality contract — which gives GP practices extra funding if they adhere to 19 separate standards — was launched in April.

These include ending lunchtime and half-day closing to create more appointments a year — but also reducing prescriptions and "reflecting on referral levels".

Nearly half of each practice’s payment from the CCG is based on meeting these targets.

CCG bosses hope the £3.4 million scheme will pay for itself by saving money on unnecessary treatments.

Dr Wirin Bhatiani, chairman of the CCG, said: “We consulted GPs on the Bolton Quality Contract over a nine-month period, providing the opportunity for GPs to shape and influence its development.

“The final contract document and indicators used to measure performance were agreed by a committee made up of representatives from Bolton Council, NHS England, Public Health England, and Healthwatch Bolton.

“The Bolton Quality Contract is an initiative that all practices in Bolton have signed up to voluntarily.

“The CCG and its member practices are committed to driving out waste to enable our limited resources to be focused on the very best care for all our patients.”

The quality contract states GPs should reflect on the referrals made by their practice and use average data to “improve referral quality and identify opportunities to reduce unnecessary hospital attendances”.

The report adds that the quality standard aims to “ensure patients receive the right treatment at the right time” rather than being sent to hospital when they can be treated by their GP.

A spokesman for Bolton CCG said the idea was to ensure patients are not referred when they do not need hospital treatment — not to limit referrals for those who need them.

Other targets include reducing unnecessary prescriptions — with 5.9 million medicines prescribed by Bolton’s GPs in 2013/14 at a cost of more than £50 million.

Doctors are also being urged to carry out fewer procedures of "limited clinical value" such as varicose vein and tonsil operations, as well as boosting attendance for cancer screenings, health checks and flu jabs.

Dr George Ogden, chairman of Bolton Local Medical Committee, said: "I welcome the investment in improving the quality of primary care in Bolton.

"The Bolton Quality Contract is an innovative initiative and the LMC worked with CCG to ensure that the investment in primary care was in the best interest of patients in Bolton.

"The GMC issued guidance which was distributed to all practices. I have been reassured that Healthwatch Bolton has been part of committee that scrutinised practice plans.”