Targets could block cancer referrals

On behalf of Attwaters Jameson Hill posted on Thursday, December 1st, 2016

In early October, shock waves were felt by patient groups, charities, negligence lawyers and many within the medical profession over media reports that General Practitioners were allegedly getting financial incentives to refer fewer patients to hospitals. This news was broken by GP-focused medical publication Pulse and quickly picked up by mainstream press, TV and social media.

In early October, shock waves were felt by patient groups, charities, negligence lawyers and many within the medical profession over media reports that General Practitioners were allegedly getting financial incentives to refer fewer patients to hospitals. This news was broken by GP-focused medical publication Pulse and quickly picked up by mainstream press, TV and social media.The incentives were quickly condemned as ‘ethically questionable’, with particular concern that the patients potentially in need of specialist attention at a hospital could include those needing investigation for cancer. Further Pulse revelations pointed to incentives running into thousands of pounds, with nine or possibly more Clinical Commissioning Groups offering the payments to GP practices that stayed within outpatient referral and follow-up targets.

“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.”

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