Points system to ration GP referrals

The NHS should consider introducing a points system to help GPs 'ration' access to NHS treatment, according to the King's Fund.

Dr Dixon: 'When money is being cut you've got to make sure the cuts don't hit those most in need
Dr Dixon: 'When money is being cut you've got to make sure the cuts don't hit those most in need

The think tank has been studying how PROMs (patient- reported outcome measures) can be used to influence decision making in the NHS.

The resulting report, Getting the Most Out of PROMs, suggests a points system could be used to prioritise patients for treatment and reduce variation in GP referrals.

PROMs are an assessment of a person's health and quality of life, completed by the patient often following treatment but sometimes ahead of it.

The tools are currently used to assess the outcomes of hos- pital operations but are being developed for use in patients with anxiety and depression.

The King's Fund report cites examples from the New Zealand and Canadian health systems, where patients complete a PROM-type questionnaire before treatment to assess how their condition affects their quality of life.

Patients receive a 'score' in points, based on their needs and the likelihood treatment will improve their quality of life.

'Those who do not have enough points to merit surgery are not offered surgery,' the report says. 'This is, in effect, an explicit form of "rationing".'

The reports' authors assess whether PROMs data can 'guide referral practices, to ensure that the people who receive healthcare are those that will benefit from it the most'.

Dr Ray Naden and Alison Barber, from New Zealand's ministry of health, write that 'the use of points systems marks a departure from a reliance on paternalistic, potentially idiosyncratic, decisions by individual clinicians'.

NHS Alliance chairman Dr Michael Dixon said some parts of the UK used points to prioritise patients in the late 1990s, and this 'was likely to return' as NHS funds dried up.

'When money is being cut you've got to make sure the cuts don't hit those most in need,' he said.

Such systems could be 'a bit of a blunt edge,' and safeguards would be required to rule out dishonesty in patients' self- assessment, said Dr Dixon.

The Conservatives last year pledged to link GP funding to the local population's health and to base QOF payments on PROMs and outcomes.

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