DoH director of system management Bob Ricketts told a King's Fund debate that PCTs should ‘monitor GP referral rates and incentivise reductions where they are overly high'.

This contradicts GPC advice that practices should avoid deals with PCTs for hitting referral- or cost-cutting targets.

GP referrals to secondary care rose 6.4% in 2009, DoH data show, despite use of referral management schemes.

PCT directors at the event urged managers and clinicians to agree local enhanced services (LESs) to compare GPs' referring patterns.

Denis Gizzi, director of system reform at NHS Oldham, was ‘surprised' the GMS contract did not incentivise ‘capacity management'.

He proposed LESs to cut unnecessary lab tests, medication, diagnostics and admissions.

‘We have to apply some technical standards [to GP referral] and incentivise practices to stay within these slots,' he said.

Conor Burke, managing director of NHS Redbridge, said the PCT benchmarked individual GPs to make them look at their performance.

GPC chairman Dr Laurence Buckman said benchmarking individual GPs was ‘one of the most inappropriate things you could do'. He said: ‘In principle analysing referrals is good for patients, but not as a cost-cutting exercise.'

• Read the full version of this story in this week's edition of GP dated 12 March