GP practices are being offered thousands of pounds to cut the number of patients they refer to hospitals, according to an investigation.

A freedom of information study found practices were being given large financial “incentives” for not sending patients to hospitals for appointments such as consultations with specialists, scans and operations.

First appointments for cancer – that should occur within two weeks of a GP suspecting the disease – are included in some of the targets to cut referrals, the study by Pulse magazine found.

The rewards are being offered by clinical commissioning groups (CCGs), the NHS bodies responsible for the planning and commissioning of healthcare in their local area. Some CCGs have argued the incentives represent no conflict of interest for doctors.



Guidance from the General Medical Council (GMC) says doctors must not accept any “inducement, gift or hospitality” that affects or could be seen to affect the way a doctor treats or refers patients.

But former Royal College of GPs chair and Lambeth GP Prof Clare Gerada told Pulse that such schemes risk “interfering with the doctor-patient relationship”. She said: “Once we start incentivising to reduce activity, then it puts a conflict within the consulting room.”

Some of the CCGs that provided details to Pulse said they were focused on cutting “unnecessary” referrals. Others had much broader targets to cut referrals for “high activity” specialties.

Pulse said at least nine CCGs – covering hundreds of thousands of patients – were offering the financial rewards. Some doctors told the magazine that CCGs were now also increasingly using them to cut costs.

Dr Emma Rowley-Conwy, a GP in Lambeth, south London, said the targets were “counter to other initiatives that encourage GPs to refer earlier for suspected cancers”.

The findings come as the eighth National GP Worklife Survey, carried out by Manchester University, found that overall job satisfaction reported by GPs is lower than in all surveys undertaken since 2001.

The lowest levels of satisfaction related to the number of hours worked and levels of pay. Between 2012 and 2015, levels of stress also increased, the survey found, with 13% of GPs under 50 saying they planned to quit direct patient care in the next five years.

Dr Rosie Loftus, joint chief medical officer at Macmillan Cancer Support, said: “It is very worrying that GPs could be put under pressure not to refer people who might have cancer, against their clinical judgment, because of targets. This is yet another sign of an NHS which is seriously overstretched and not giving GPs the resources and support they need.

“England’s cancer survival rates are already amongst the worst in Europe and a key reason for this is the inadequate access to cancer tests and treatment. If this is rationed further it could make survival rates and quality of life for people with cancer worse. This isn’t something the NHS can afford to do.”