The BMA has issued new guidance to GPs that they should not take part in referral management schemes that offer practices financial incentives for cutting patient referrals.

The new BMA guidance publication from their GP Committee offers GPs in England guidance on referral demand management and analysis schemes. _These initiatives are designed primarily to help GP practices examine the way they refer patients to other services, such as hospitals.

Referral schemes have developed in response to rising patient referral rates. They were widely introduced during the NHS’s financial recovery period from 2006-7, when large deficits were emerging.

Referral management schemes were created by many primary care trusts (PCTs) to offer community-based alternatives to hospital care that were cheaper for the PCTs to fund. They were also used as a mechanism of triaging GP referrals to check their appropriateness. Their popularity among GPs has, as a result, been very mixed.

Showing the money
More recently, the BMA’s statement adds that “variations have emerged that offer GPs financial rewards for cutting referral rates to pre-agreed levels set in co-operation with local health bodies”.

The new guidance’s main conclusions are:
1. “When developed in partnership with doctors, referral management schemes can provide benefits to patients by allowing GPs to discuss non-urgent cases with their colleagues. This can result in patients being offered an alternative course of treatment and GP practices identifying services they can develop for the benefit of their patients. As practices would incur extra costs by taking part in these schemes it is acceptable for them to receive some extra funding.
2. It is not acceptable for practices or groups of practices to receive funding or payments for schemes that provide specific financial rewards for reducing referral numbers or costs to certain levels or by certain amounts. These types of target-based schemes could result in a perverse incentive to reduce referrals”.

Dr Laurence Buckman, Chairman of the BMA’s General Practitioners Committee, said, “properly run referral schemes can improve patient care. They have the potential to reduce the pressure on local hospitals, provide patients with a greater say over their care and help them obtain treatment in their local community. They also give GPs an idea of what services they might want to develop “in-house” at their practice.

“However, it is not acceptable for these schemes to provide specific financial rewards to GP practices which reduce patient referrals to pre-agreed levels or by certain amounts. This doesn’t help anyone – patients, local services or the wider NHS.

“We understand that in some areas of the country referral rates are rising, putting extra financial pressure on the NHS. But health managers must not seek to tackle this problem by setting up target based referral schemes. All referrals must be driven solely by what is in the best interests of the patient.”