GPs Bonuses for denying treatment

[QueenBathsheba]

In the Health and Social Care bill and as reported today in the news. GPs will be given cash bonuses for saving money.

GPs Consortia some of which will be run by private consultants/companies will hold 80% of the NHS budget.

GPs have always been considered to be the gatekeepers to the NHS but now they will actively be given incentives to deny treatment and referals to specialist services.

I am appalled and feel that this will create a two tier system of health care, where GPs will not first ask you what is wrong but are you insured? because for every penny they save they will be rewarded.

I am wondering what other people think.

There will be an increase in patients having to pay for a private consultation just to be referred, if that is the case.

Could you link the article?

The Bill seems to have passed its Second Reading today, and there's an interesting critique of it by doctors (ie the BMA) here.

It doesn't mention denying treatment though. It does mention that price becoming a factor in referrals may lead to a diminution of the quality of treatment though.

Sorry for the delay, here is a link to the article in the mail www.dailymail.co.uk/news/article-1361676/GPs-paid-bonuses-hold-care.html

I read about it here first though

The Commissioning Board can award performance payments to Consortia, the 'appropriate' distribution of which is open to interpretation. The rationale for these bonuses may be to operate along the lines of incentive payments used in the USA, where GPs are rewarded for sending fewer patients to hospital. With savings of £20bn to be found, and staff redundancies and longer waiting times already likely, this section of the Bill is seriously worrying, yet has generally been skipped over in media coverage.

www.redpepper.org.uk/the-worst-fears-confirmed-dissecting-the-health-and-social-care-bill/

I also had a look on the parliment website, you are invited to write in but strangely can't get to read the bill in it's enterity.

www.parliament.uk/business/news/2011/january/health-and-social-care-bill-second-reading-/

Any ideas on how you can get to read the full bill?

Thanks for the link Meditrina, I'm off to have a read.

I wouldn't trust them as far as I could throw them!

I've just read that the Public Accounts Committee have just published a report on cancer survival rates. They have stated that the survival rates are lower for people in lower economic groups and much of the problem is down to GPs missing out on the signs and failing to refer.

If GPs are encouraged to not refer on the basis of cost, survival rates will plunge not increase.

I agree.

I am a GP (not working at present) and I am very worried by these developments. It really jeopardises the role of the GP as patient advocate.

It will create a difficult relationship between GP and patient. I always asumed that GPs were free to advocate and support patients, now they might see patients as potential expense and loss of bonuses.

It should be that incentives for GPs are set against validated health improvement criteria, and this was the case with the previous set of reforms (not that they were in any way perfect). So GPs that provided really good preventative care in effect got bonuses. They would also expect to see less referrals to secondary care because of their success in managing in particular chronic diseases. This was a win all round, an incentive for GP practice to employ specialist nurses to support their patients (good holistic care appreciated by patients too).

There have also been incentives in the past to discourage inappropriate referrals (generally referrals where initial tests hadn't been carried out, or those with very weak criteria), and this can also be an indicator of poor care (where a doctor is not up to date or lacks confidence) although this woudl be combined with other factors.

btw all of the consortia will be in effect privately run, as GPs are not NHS employees but contractors.

My major concern is that a large amount of the work of PCTs (now to be abolished) was to monitor GP performance and to act where there were concerns (many GPs are fantastic, most are average, some need incentives and sanctions and a very small number are bordering on dangerous). I'm not in the NHS anymore, but I really wonder how this role will be undertaken in the future. One of the significant recommendations after Shipman was that PCTs should manage complaints about GPs, this was never implemented and I wonder who patients will be able to raise their concerns with in future.