GPs are being offered cash payments not to refer patients to hospital, in a move which leading family doctors have criticised as ethically questionable and a risk to health.

NHS bodies in four parts of England are using schemes under which GP practices are given up to half of the money saved by sending fewer patients to hospital for tests and treatment.

The disclosure by the GP website Pulse about the controversial “profit share” initiatives operated by the four NHS clinical commissioning groups (CCGs) has triggered a row.

Critics said the schemes were the latest example of NHS bodies increasingly resorting to the rationing of care to help them operate within their budgets.

NHS Coastal West Sussex CCG has offered to give groups of practices working together in its area 50% of savings made from GPs referring fewer patients for dermatology care, ear, nose and throat treatment in the community, and minor surgery and wound closure.

Helen Stokes-Lampard, chair of the Royal College of GPs, said: “Cash incentives based on how many referrals GPs make have no place in the NHS, and frankly it is insulting to suggest otherwise.” Family doctors did need help to ensure they were refer the right patients but that should not involve “ethically questionable initiatives that prioritise cash savings over patient care”, she said.

Peter Swinyard, chair of the Family Doctor Association, said: “From a patient perspective it means GPs are paid to not look after them. It’s a serious dereliction of duty, influenced by CCGs trying to balance their books.”

England’s 207 CCGs hold the budget for the NHS locally and decide which services are provided for patients. NHS West Leicestershire, which is offering federations of GP surgeries 30% of savings resulting from fewer “first referrals”, said the scheme was designed to cut the number of “clinically unwarranted and unnecessary referrals, particularly into secondary care” and would let hospitals treat the most needy cases.

A freedom of information survey of 181 CCGs by Pulse found that a quarter offered some sort of financial incentive to GPs to cut referrals. Eleven involved a direct incentive to GPs to alter their referral behaviour, four of which involved “profit-sharing” schemes.

NHS England, which funds and supervises CCGs, declined to comment, but Amanda Doyle, co-chair of NHS Clinical Commissioners, which represents CCGs, said: “Ensuring patients get the best possible care against a backdrop of increasingly squeezed finances is one of the biggest issues CCGs face. Directly linking payments to reductions is not appropriate and NHS England, as the regulator, would take a role in addressing that circumstance.”

Jonathan Ashworth, Labour’s shadow health secretary, said: “Minister should step in and ban this practice immediately. Patients should be referred for treatment on the basis of their medical needs. These cash handouts – which some might even describe as ‘bribes’ – to block referrals are totally unacceptable and the latest pernicious effect of Tory underfunding of our NHS.”



The Department of Health and Social Care made clear that no patient should be denied care. “Patients must never have their access to necessary care restricted - we would expect local clinical commissioning groups and NHS England to intervene immediately if this were the case,” a spokesperson said.

