GP practices given cash back for not sending patients to hospital

CREDIT: This story was first seen in The Telegraph

GP practices are being given ‘cash back’ for preventing patients from going to hospital, under ‘profit-share’ agreements, which were last night condemned by patients’ groups, The Telegraph reports.

An investigation reveals that one in four NHS authorities has introduced financial incentives for GP practices which reduce the number of patients referred to hospital.

They include schemes which mean practices can keep up to half of all savings generated, if they stop any rise in the numbers going to hospital, despite an ageing population. Others receive an extra £5 for every patient kept out of hospital, if referrals are cut by 10%, under a £1.4m scheme.

Patients’ groups said the policies were “truly disgusting” while leading GPs described the schemes as “ethically questionable” as they called for them to be halted.

It comes amid polling showing satisfaction with GPs has slumped to the lowest level in 35 years, with a sharp fall in the last year.

Think tanks said the findings from the British Social Attitudes survey were alarming, with a service once seen as “the jewel in the crown of the NHS” was “really in decline” with satisfaction levels falling by seven per cent in just one year.

Freedom of Information disclosures from 181 clinical commissioning groups (CCGs) reveal 44 are now offering practices financial incentives in order to cut referrals to hospitals.

Many practices received a financial boost for setting up systems which meant every referral was double checked by another clinician before being allowed to go ahead.

But the investigation by Pulse also reveals eleven schemes where sums paid out were directly linked to cutting referrals, including “profit sharing” schemes which meant practices could receive up to half of all savings made.

CCGs said the schemes aimed to reduce unnecessary referrals, which would improve outcomes for patients. They said savings should be reinvested in services, not paid to GPs, whose earnings are derived from practice incomes.

NHS Coastal West Sussex, practices are being allowed to keep 50% of savings made from reducing the number of patients sent to hospital for surgery. NHS Enfield in north London has introduced similar plans for GPs who cut the number of patients sent to see specialists.

In NHS West Leicestershire, practices can receive 30% of any savings from cutting initital referrals to hospital.  NHS Rotherham’s pays GP practices £3.36 per patient for hitting targets, which include cutting hospital referrals, with no exclusions for patients who may have cancer. And Barnsley CCG aims to cut referrals by 10%, across a range of specialties – including heart care – in a scheme which a local GP described as “unsafe”.

Dr Peter Swinyard, chairman of the Family Doctor Association said the schemes were damaging patient care, and should not be stopped.

“From a patient perspective, it means GPs are paid to not look after them. It’s a serious dereliction of duty, influenced by CCGs trying to balance their books.”

Professor Helen Stokes-Lampard, Chairman of the Royal College of GPs, said:“GPs need support to ensure that referrals are appropriate – not ethically-questionable initiatives that prioritise cost-savings over patient care.

“Cash incentives based on how many referrals GPs make have no place in the NHS, and frankly, it is insulting to suggest otherwise,” the leading doctor said.

Joyce Robins, from Patient Concern, said: “Any sort of financial incentive like these is an entirely dreadful way to run the service.

“I think it’s truly disgusting – the very idea of cashback for GP practices that don’t refer patients to hospital undermines any trust between a patient and their doctor.”

The survey of 3,000 people found satisfaction with the NHS is the lowest since 2011,  at just 57%.

The polling found satisfaction with GPs fell seven percentage points in a year, to 65, compared with 80% less in 2009. Long waits to get an appointment, staff shortages and lack of NHS funding were fuelling growing concern, the Kings’ Fund and Nuffield Trust said.

overall and 1,000 people about their feelings on individual services, found that 65% of people said they were satisfied with GP services, the lowest level since the survey began.

It is now no longer the highest rated service and on par with outpatient services – which also has a 65% rate of satisfaction among the public.

Ruth Robertson, fellow at The King’s Fund, said: “One of the findings I thought was most striking in this year’s survey is the slump in GP satisfaction.

“Actually the public used to put GPs on a pedestal. They rated general practice much higher than other services.

“But since 2009, when the public satisfaction with general practice was 80%, it has been steadily declining.

“And now for the first time, general practice is no longer the highest rated service. I think it is showing the huge pressure on general practice and the public are responding to that.

“This is a service that people used to see as the jewel in the crown of the NHS and it is no longer the highest rated service. It is really in decline.”

But she added: “More people are satisfied with the NHS than are dissatisfied and when we asked them why they are satisfied they showed really strong support for the core value principles of the NHS – being free at the point of use, the comprehensive range of services available.

“I think that this shows that it is not falling out of favour, but people are worried about the NHS and they are worried about funding and staffing shortages.”

Professor John Appleby, chief economist and director of research at the Nuffield Trust, said the Government should take “serious note” of the significant drop in satisfaction.

“When we asked people why they are dissatisfied, it is increasingly less to do with pointing the finger at the NHS, and increasingly switching the blame to bigger issues – funding, staffing – which are of course the responsibility of Government policy,” he added.

“The Government may think the NHS is safe in their hands, but the public disagrees with that,” he added.

Professor Stokes Lampard, said the findings were “symptomatic of the inevitable effects of a decade of under-investment in our family doctor service – and just not having enough GPs in the system to meet demand.”

Labour’s shadow health secretary Jonathan Ashworth said: “This survey is the clearest message to Theresa May that the Tory agenda of under-funding, cuts and privatisation must come to end.”

An NHS England spokesman said: “While it is encouraging that for the second year in a row public concerns about waits have reduced, and public confidence that the NHS is using its funding well has again increased, these results understandably reflect a health service under pressure.

“With public satisfaction scores ranging from 65% for GPs to 23% for social care, these findings again confirm the public’s enduring support for the NHS and the measures necessary to sustain it.”

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