The NHS Alliance, which represents primary care, has called for the General Medical Council (GMC), which regulates doctors, to issue guidance on acceptable practice in NHS primary care trusts’ incentive payments to GPs.

Current GMC rules state that doctors must not accept or offer any inducement that might affect – or be seen to affect – the way they treat or refer their patients. Conflicts of Interest, GMC rule 74 says, “you must act in your patients’ best interests when making referrals and when providing or arranging treatment or care. You must not ask for or accept any inducement, gift or hospitality which may affect or be seen to affect the way you prescribe for, treat or refer patients. You must not offer such inducements to colleagues”.

NHS Alliance has called for more specific GMC guidance on good and bad practice.

PCTs have come under financial pressure from an increase in GP referrals to hospital. This iscrease both costs PCTs money to pay for the care and also threatens the strong progress being made on the Government’s target to reduce waiting time from referral to treatment to 18 weeks by December 2008.

The adoption of NICE guidance has also moved minor operations formerly done by GPs into hospital, and the fall in NHS waiting times associated with the NHS target is anecdotally reported to be bringing patients back into the NHS who would otherwise have god private.

How GPs refer
NHS Alliance suggest that the GMC policy “appears to mean it is acceptable to pay incentives to GPs to review the way they refer. Regular review is good practice: it can highlight any issues about low referrals as well as high, educate doctors about possible alternatives to hospital treatment, and improve medical practice. But any doctor who accepted a payment to cut the numbers of referrals, or not to refer, might be acting wrongly”.
NHS Alliance’s figures point out that a first hospital referral costs between £100 and £200, while a GP appointment typically costs around £25.

Dr David Jenner GP, of the NHS Alliance national executive, said, “we don’t believe that doctors’ decisions to refer are being influenced by incentive payments. That would clearly be wrong and in breach of the rules. However, the rules aren’t just about accepting inducements. Doctors should not give the appearance of acting in a way that isn’t in the patient’s best interests.
“These new schemes seem to be in a grey area that has never been considered before. It is only the GMC who can issue professional guidance and they should do so immediately – not only for the sake of patients and their GPs, but also for PCT medical directors who could be accused of offering inducements.”