“My colleagues and I were as shocked as anyone,” says our firm’s Madeline Seibert. “An effect of giving a financial reward for keeping referrals below a certain level could be to deny some patients access to the hospital tests or investigations they need to find out whether they have a serious illness. That cannot be sensible, responsible or ethical, even if the NHS is under severe financial pressure. The public outcry has been fully justified in my view.”

Reports suggested that one London CCG was offering incentives to cut a broad range of referrals from which two-week cancer referrals and other urgent cases could not be separated. A Midlands CCG’s incentives to cut outpatient and emergency cases were valued at about £11,000 for the average GP practice. An East Midlands CCG’s payments on offer equated to around £6,000 per practice.

There were denials that the CCG arrangements were detrimental to patients’ interests, but others in authority disagreed. For instance, extreme concern was expressed by the chairman of the BMA General Practitioners Committee, who added that there could be breaches of General Medical Council guidelines. There was also a feeling among some GPs that the doctor-patient relationship could be affected. A shocked reaction came from the head of a cancer charity and an NHS crackdown also followed.

“I’m glad that this whole issue was brought out into the open,” Madeline Seibert adds. “Anything that means the response to patient needs can be decided on financial rather than medical grounds must be wrong. I hope that all CCGs will take note of the furore and ensure that no patient’s hospital referral is stopped or delayed because some kind of quota has already been filled.”