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.

Candace Imison, King's Fund deputy director of policy said cutting referrals to hit targets was dangerous for patients.

‘The use of norms and averages [when monitoring referral rates] needs to be treated with extreme caution,' she said.

‘There are many reasons why one GP may refer a patient on while another chooses to manage them.'

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

GPC chairman Dr Laurence Buckman said benchmarking individual GPs was ‘one of the most inappropriate things you could do'.

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