The government has told primary care trusts (PCTs) that incentive schemes which pay GPs to cut referrals to hospital must be designed to ensure the best clinical care of patients.
After last week’s revelations, that is an important first step. Now the General Medical Council (GMC) should issue guidance on what is – and what is not – acceptable, the NHS Alliance says. That is the only way to make sure that the interests of patients are seen to come first, and that their doctors and PCTs are protected from accusations of bad practice, or even harming patients.
GMC rules say that doctors must not accept or offer any inducement that might affect – or be seen to affect – the way they treat or refer their patients. That appears to mean it is acceptable to pay incentives to GPs to review the way they refer.
Regular review is good practice: it can highlight any issues about low referrals as well as high; educate doctors about possible alternatives to hospital treatment; and improve medical practice. But any doctor who accepted a payment to cut the numbers of referrals, or not to refer, might be acting wrongly.
In the absence of professional guidance, both GPs and PCT medical directors could stand accused of breaking GMC rules if a patient came to harm following a decision not to refer, even if that decision was in line with good practice.
Dr David Jenner, an NHS Alliance national executive member and a GP in Devon, said: “We don’t believe that doctors’ decisions to refer are being influenced by incentive payments. That would clearly be wrong and in breach of the rules. However, the rules aren’t just about accepting inducements. Doctors should not give the appearance of acting in a way that isn’t in the patient’s best interests.”