The Department of Health has confirmed that it asked the NHS Confederation and NHS Employers to consider how a tariff (the nationally set fixed price) could work for access to non-GP surgery primary care, such as walk-in centres and minor injury units. This draft document also considers possible 'fines' for GPs whose registered patients use A&E to meet their primary care needs. The new issue of Health Service Journal disclosed the existence of a draft report looking at these ideas.

The draft document is allied to the DH policy on getting GP surgeries to open for longer hours, and seeks to create incentives to reduce what is considered inappropriate use of casualty and minor injury departments.
A&E attendance has risen significantly in recent years, and this step would, if implemented, seek to recover the money spent treating patients in A&E if their need could and should have been met in primary care.

However, its practical implementation is likely to be fraught with administrative problems. And it will reopen the debate about access to primary care - and also over public knowledge of how best to access NHS services out of GP surgery hours. Walk-in centres, minor injury units, urgent care centres and out-of-hours bases have all added to the mix since GPs were able to divest out-of-hours provision under the new contract in 2003.

Fines for GPs unpopular with GPs
Nor is it likely to be popular with GPs in some areas. Dr Laurence Buckman, chairman of the British Medical Association's GPs' committee, described the suggestion as unworkable. "Charging back costs if patients went to A&E or elsewhere would not be an incentive, it would be a punishment and work as a disincentive to work in areas with high A&E use."

Dr Michael Dixon, chairman of the NHS Alliance suggested that such a scheme might be able to work in areas where GPs held budgets and were responsible for commissioning services. However, he warned that it could risk penalising the care for patients with long-term conditions (such as asthma, diabetes and heart disease) which make up; the bulk of primary care’s work and prevent admissions to hospital by keeping patients in manageable health.

Under the current system, bills for A&E attendance are paid for by the locality's administrative primary care trust (PCT). Some hospitals and PCTs have collaborated to put a 'GP front end' on A&E departments, such as Whipps Cross in east London.

By Andy Cowper