BMA urges GPs to 'avoid' target-based referral reduction schemes

The BMA has condemned a scheme that pays bonuses to GPs for not referring patients to hospital.

Oxfordshire PCT has introduced a policy which means that practices can be rewarded for reviewing and reducing referral rates. An average-sized practice can reportedly earn up to £20,000 extra a year.

If practices hit their targets, Oxfordshire PCT would pay out £1.2m but it said this was justified because increasing hospital referrals were costing £6m.

BMA spokesman said: ‘Referral schemes can in many cases enhance patient care by introducing procedures whereby individual GPs can discuss non-urgent referrals with their colleagues.

‘When implemented properly, they allow doctors to share knowledge and find better ways to treat their patients by, for example, referring a patient to a GP who specialises in a particular condition or to a local service that provides care on manageable conditions such as diabetes. This can help a patient receive efficient care in their community and has the potential to reduce pressure on hospital services.

‘It is important that referral schemes are introduced only after full consultation with local clinicians and that they have clear, transparent guidelines of operation. Schemes that include targets based on reducing referral rates should be avoided as GPs should make referral decisions based on clinical factors.

‘GPs will always ensure that their patients are referred immediately to hospital or specialist care if they require urgent treatment.'

Shadow Conservative health secretary Andrew Lansley said: ‘It is inefficient and unethical to pay GPs to refer fewer patients to hospital. It would be so much better if GPs, not bureaucrats, had responsibility for their patients' budgets. It is GPs who should be making the decisions about the best use of resources and how best to meet the needs of their patients. ‘If patients find out that their local health bureaucracy is paying their GP not to refer them to hospital they will be rightly outraged.'

Editors blog: Another incentive to bash GPs

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