In an audacious move, the public health system in the UK is to offer monetary rewards to doctors for keeping patients away from hospitals. That is an attempt to reduce the state's healthcare burden.
That way doctors could stand to earn thousands of pounds extra under the initiative, reports say.
In a variety of schemes, which differ from region to region, General Practitioners (GPs) are said to have been offered unprecedented cash incentives for deciding not to refer a patient for specialist treatment. Surgeries are given a target of how many patients they should refer to hospital each year and will receive a windfall payment if they meet the quota.
Conversely, the money is lost if the surgery sends more patients to hospital than allowed for under the health authority target.
The Mail on Sunday has established that in Oxfordshire each surgery will be given a target of how many patients it should refer to hospital every year. If it meets those quotas, it will be eligible for a bonus payment of up to £10,000.
GPs in the region will be paid a similar amount to set aside additional time to review decisions on whether patients should be given hospital appointments.
It was reported last night that under another local scheme, doctors in Torbay in Devon could make £59 for every patient not referred. Practices in London, Essex and Wiltshire were said to be in line for £4.50 for every patient on their list if they meet targets which include a curb on the number of referrals.
The initiative will cause deep unease, even among doctors who could profit from it. Commenting on the Oxfordshire scheme, Dr Laurence Buckman, chairman of the British Medical Association's GP Committee, told The Mail on Sunday it was 'morally dubious, ethically disturbing and quite wrong'.
The schemes are seen as an attempt by NHS managers to direct patients away from the overloaded hospital system towards cheaper health workers, such as physiotherapists.
But Stephen Cannon, a consultant surgeon at the Royal National Orthopaedic Hospital, said last night that potentially fatal tumours had already gone undiagnosed because of the scheme.
He said: 'I recently encountered two cases in which patients referred to physiotherapists later turned out to have a malignant tumour. In one, a young man was referred to a physiotherapist because of sudden knee pain. Had he come to a specialist the symptoms should have been recognised and he should have been urgently referred to an oncologist. In this case, after the delays, the outcome was amputation. It was devastating for the patient and his family.'
The Oxfordshire scheme was introduced on October 1 in a bid to save money because health chiefs feared they faced a £23million overspend. Eighty out of 82 practices in Oxfordshire have signed up and £1.2million has been allocated to be shared among them.
All 62 practices in Wiltshire have reportedly joined their local scheme, and 24 practices in Essex are said to have followed suit.
Hampshire health chiefs are said to have promised surgeries payments of up to £4,000 if they keep hospital referrals on target.
Dr Buckman said: 'The idea that we should pay doctors to behave in a particular way is worrying. There is a huge difference between paying GPs to increase vaccination levels - which is public health policy and therefore perfectly reasonable - and rewarding them for not referring a patient.
'Many patients are referred for further investigation rather than treatment and it would be incredibly dangerous if these patients failed to get hospital appointments simply because GPs decided they weren't sure if a referral was strictly necessary.
'The reason for a rise in referrals is very complicated and this isn't the way to deal with it. We should be trying to understand the reason for the referrals.'
Oxfordshire Primary Care Trust insisted it is not paying GPs not to refer but to review their practices, and that every patient who needs to be referred to hospital will get an appointment. Alan Webb, director of commissioning, said the Trust hoped the savings made would go back into patient care.