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Paying GPs to not refer patients is deeply unethical

An investigation by Pulse magazine has shown that some Clinical Commisioning Groups are offering GP practices up to 50% of the savings made if they send fewer patients to hospital for elective care. From the patient's point of view, it would seem that the CCG finds it cheaper to send the GP a cash bung than to pay for the patient's care. Alarmingly, one CCG is even applying such a system to cancer referrals.

There is minimal evidence that cash incentives actually make any difference to GP referral rates. A study in the British Journal of General Practice suggests that Referral Management Centres (RMCs), firms which are paid to triage GP referrals and make savings by refusing care, are costly and ineffective. Further evidence suggests that these systems can delay urgent care, prevent appropriate referrals from getting through, and add a layer of unnecessary complexity that reduces quality of care. With CCGs deciding on arbitrary targets to cut GP referrals, it is likely that these unevidenced practices will worsen and it will be patients who pay the price.

NHA co-leader Dr Alex Ashman said, "Paying GPs to not refer patients to hospital for elective care is deeply unethical. In theory this 'cash for cuts' might seem like a good idea to managers, but in practice the evidence suggests there is no benefit and a real risk of harm. The conflict of interest this creates is worrying indeed. We call on NHS England to ban CCGs from giving GPs and RMCs 'cash for cuts'."

GP and NHA spokesperson Dr Louise Irvine said: "Cash incentives to discourage GP referrals is no way to deal with inadequate NHS funding and will create risk for patients. GPs should refer, as they always have, on clinical grounds only. GP practices are desperately underfunded too and should not be under pressure to short change their patients in order to get much needed funds. GPs will reject such false incentives, which undermine trust in GPs and the doctor-patient relationship.

"In the long run the undermining of the GP's role as the patient's advocate, acting always in their best interests, will lose the NHS more money because it is proper trust based personal and continuing GP care that has actually made our NHS so efficient up to now. Proper investment in GP services is what is needed - not these false economies that cause more harm than good."

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The National Health Action (NHA) Party was founded in 2012 to oppose the growing marketisation of the NHS.

Dr Irvine stood against Jeremy Hunt in his SW Surrey constituency in the 2015 and 2017 General Elections, taking 12,093 votes in the latter: a 7.8% swing to NHA.

Dr Ashman is a surgical registrar who joined the NHA in 2012 having seen first hand the effects of marketisation and privatisation on the NHS.

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