The Primary Care bible, Pulse, today led with an article about GP practices being offered “ethically questionable” incentive payments to reduce hospital referrals. Pulse’s investigation reveals that no fewer than nine CCGs are offering the payments, which extend in some cases even to rewarding practices for cutting down on their 2-week cancer referrals.
As former RCGP chair Clare Gerada said, “once we start incentivising to reduce activity, then it puts a conflict within the consulting room”.
And what a conflict. With GPs feeling the financial pinch more than most, offers of thousands of pounds to reduce referral activity must be very difficult to ignore. But exactly what behaviour is it going to incentivise – doing things differently or taking more risks with patients?
It depends on what tools are at the GP’s disposal. If the GP has no help available, how will an incentive make them do things differently? The only thing they can do is to exercise their professional judgment differently. For any GP, the idea that they will allow their professional obligation to do their best for the patient to be compromised by a financial bonus is hard to swallow. I don’t know a single GP who would change their approach to risk for money.
But give a GP a tool or a plan to reduce referrals and incentivise them to use it and it is a different story. For example, within the practice, encouraging peer review of referrals allows GPs to tap into the communal expertise of all their clinicians. More knowledge means better judgment means less referrals. The right behaviour is incentivised, referrals drop and everyone is happy.
Consultant Connect works on the same principle – except in this case you are able to go beyond the walls of your practice and harness the knowledge of local specialty hospital consultants. By giving GPs immediate access to consultants (the typical wait time to speak with a local consultant is under a minute), the GP can discuss the patient’s case with the consultant whilst the patient is still with them, getting clear advice & guidance on the right choice of care for the patient. In some cases a referral will be necessary, but in others the consultant will be able to help the GP offer care that will avoid a trip to hospital. Where Consultant Connect is working in Essex and Merseyside, approximately 70% of calls conclude in the patient not being referred.
So incentives CAN work to reduce referrals without causing conflict or compromising patient safety – but only where the GP is given the option of doing things differently. An incentive alone is no incentive at all.