GPs in some areas of England and Wales are actually being offered cash to cut the number of referrals to hospitals under the drive to gather efficiency savings, putting patient health at risk, according to the British Medical Association's new head Mark Porter.

Primary care trusts (PCT) and clinical commissioning groups (CCGs) are offering GP practices financial incentives to refer less patients for costly hospital care, going against advice to improve the quality of referrals on clinical grounds alone, Porter, who was recently elected head of the BMA council, told The Guardian.

One example cited its that of Harrow PCT in London, which is reportedly stumping up £4 extra for each patient on GPs' books if they manage to "optimise the use of outpatient appointments to reduce the inappropriate variation in referral rates across Harrow practices", according to the newspaper.

But Porter argues that this latest example of rationing in the National Health Service is "morally wrong", and it certainly seems to illustrate the lengths to which some factions of the Service are prepared to go in order to meet the tough efficiency goals.

The Department of Health has since stressed that it will put a stop to PCTs and CCGs from offering GPs this kind of deal, promising: "If local health bodies stop patients from having treatments on the basis of cost alone then we will take action against them".

Nevertheless, the coalition government's unpopular healthcare reforms, an increasing infiltration of private organisations into the Service, and £20 billion by 2015 savings target seem to have created a culture in some areas of the NHS that is primarily focused on saving money, regardless of the affect on patients. 

Restricting access?

As a consequence of this, the NHS is risking patient health by denying access to medicines and operations under rationing to save cash, Porter said.

The number of treatments some organisations are prepared to fund is shrinking, so "bits of the NHS are being parcelled off and taken out of the NHS offer year by year", he argues, adding: "It's no longer a comprehensive service. We can see the effect of people to whom we have to say: I'm sorry, this treatment is no longer available".

Unsurprisingly, the DH has rejected his claims. "The NHS is treating more people and we are increasing the NHS budget in real terms, investing an extra £12.5 billion in the NHS over the course of this parliament," it said.