GPs offered cash incentives to reduce referrals for cancer tests

Dr Referral

GP practices in England are being offered thousands of pounds in cash incentives for meeting targets to reduce numbers of patients being referred to hospital for tests, including suspected cancer patients, an investigation by Pulse has found.

According to information obtained by doctor's magazine Pulse, the scheme includes referrals for a range of diagnostic procedures, including scans and consultations for cancer patients.

The Pulse investigation found that at least nine clinical commissioning groups (CCGs) across England were offering such payments - with one CCG found to be offering more than £11,000 to surgeries who were reducing referrals to outpatient services, for scans and follow up appointments, direct referrals to A&E and emergency admissions, and - in some areas - to include urgent two-week cancer referrals.

Pulse reports that one such scheme has been investigated by regulator the General Medical Council to check if it conforms to Good Medical Practice (GMC) after local senior GPs had reported their concerns.

The General Practitioners Committee (GPC), which represents all NHS GPs in the UK, has described the schemes as "ethically questionable" but one CCG told the magazine that it is confident that there is "no conflict of interest". The British Medical Association says the incentives are "misguided".

Patient-doctor trust

Dr Chand Nagpaul, chairman of the GPC told the BBC that cash incentive schemes were a "financial contaminant" to patient-doctor trust.

Cash Notes

He says: "It's short-sighted and misguided of CCGs to introduce such mechanisms, because they do lead to the potential for patients questioning the motives of GP referrals.

"We believe it is far more appropriate for CCGs to introduce clinical pathways that ensure patients are referred appropriately rather than these crude, salesman-like bonuses which pay GPs simply to make reduction to referrals in numerical terms."

Delayed diagnosis

In November last year the NHS advisory board urged GPs to try to double referral numbers for suspected cancer cases after the National Institute for Health and Care Excellence (NICE) said that as many as 10,000 people may be dying every year as a result of delayed diagnosis.

A spokesperson for NHS England says: "We explicitly want to increase not deter appropriate referrals for cancer checks."

Dr Rosie Loftus, Joint Chief Medical Officer at Macmillan Cancer Support says of the findings: "It is very worrying that GPs could be put under pressure not to refer people who might have cancer, against their clinical judgement, because of targets. This is yet another sign of an NHS which is seriously over stretched and not giving GPs the resources and support they need.

"England’s cancer survival rates are already amongst the worst in Europe and a key reason for this is the inadequate access to cancer tests and treatment. If this is rationed further it could make survival rates and quality of life for people with cancer worse. This isn’t something the NHS can afford to do.

"Macmillan is urgently calling on the Government to fully fund and implement all of the recommendations in the recently published Cancer Strategy, including giving GPs direct access to key investigative tests and increasing capacity in the NHS for the number of people who can be sent for testing."

The investigation comes as the NHS works to identify and implement £22 billion of cost efficiency savings by 2020.

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Georgie Fenn, writes most of our news articles and social media posts.