General practitioner

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Regulator shares GP doubts about referral incentives

The GMC has confirmed GP leaders’ fears that controversial schemes offering payments for reducing patient referrals could be unethical.

The BMA GPs committee last week asked the GMC to express a view on whether specific schemes breached the principles set out in the regulator’s blueprint for standards, Good Medical Practice.

GPC chair Laurence Buckman said doctors leaders had condemned as ‘utterly unethical’ schemes that offered financial rewards to GP practices if they cut the number of patients they sent for outpatient appointments or elective procedures.

Dr Buckman said: ‘Taking money from patient care, and pocketing it for reducing something you do for patients by a fixed percentage or number is wrong.’

He added that it was reasonable for doctors to examine their referral patterns and ensure they were ‘being careful with state resources’, but setting a target was a different matter.

The GMC also agrees that financial incentives can provide a legitimate way of influencing or changing a doctor’s behaviour.

GMC letter

In a letter to Dr Buckman, GMC chair Professor Sir Peter Rubin says the regulator is unable to state definitively whether the specific schemes referred to by the GPC would breach GMC guidance.

But he writes: ‘Any scheme which results in care to patients being compromised will be in breach of our guidance both in relation to accepting incentives, and on the duty to provide a good standard of practice and care.’

He adds: ‘We expect doctors to consider these schemes carefully, to review, where possible, the evidence on which they are based, and to satisfy themselves that in participating they will not be compromising patient care.’

Paragraph 74 of Good Medical Practice states: ‘You must act in your patients’ best interest 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.’

The GPC will consider the GMC’s views.