The Royal Bournemouth and Christchurch NHS Foundation Trust says Bournemouth Teaching PCT is commissioning 25 to 40 per cent less activity in 2006/7, although the PCT disputes the figures.
A cluster of four PCTs in North Yorkshire has written to GPs calling for a 30 per cent reduction in referrals, because current referral rates are 'above the national average', according to local GPs. The trusts have issued lists of procedures that will no longer be funded, and LMC leaders say the PCTs are commissioning less work from hospitals to reflect this.
Other PCTs are resorting to threats to prevent GPs referring.
GPC member Dr Fay Wilson said that a north London PCT had told GPs their global sums would be cut if they referred for procedures that the PCT did not want to pay for.
'The PCT is saying if you send patients for this particular service, we will take it off your global sum,' she said.
In Wessex, PCTs are seeking to cut referral rates by 5 to 10 per cent.
Most are trying to insert a target to this effect into the directed enhanced service for practice-based commissioning.
One Wessex PCT is in negotiations with the LMCs over a possible local enhanced service under which a 5 per cent cut in referrals would trigger an initial incentive payment, with a second available for a 10 per cent cut.
GPs say setting artificial targets for reducing referrals is unfair.
GPC chairman Dr Hamish Meldrum said the GPC was aware of widespread attempts to cut referrals. But he warned: 'I think 30 or 40 per cent cuts are virtually impossible. It would either mean that that percentage are currently inappropriate or that you are cutting services that people actually need. There is little evidence that GPs refer inappropriately. Appropriate levels may differ from area to area.'
Bradford and North Yorkshire LMC secretary Dr John Givans said: 'PCTs do not have the data to prove that such a high proportion of referrals are unnecessary.'
Dr Givans said GPs would continue to refer if they believed it was in a patient's interest, but warned that hospitals could refuse referrals if they were not paid.
GPC member Dr Chaand Nagpaul said: 'No GP should feel compelled not to refer when they think it is necessary clinically.'
- Opinion, page 25.