Tuesday, 1 December 2015

PoliticalSpeak & BrainHealth: financial incentives to reduce specialist referrals

New incentives will increase the delay in being diagnosed with MS. #PoliticalSpeak #BrainHealth #MSBlog

"I read last week's BMJ and was horrified to read that GP practices are being given money to cut the number of referrals they make to specialists. A FOI investigation by the GP rag Pulse has uncovered that several clinical commissioning groups (CCGs) are offering GP practices large payments for keeping within targets for specialist outpatient referrals. Some of the incentive schemes are even counting 2-week cancer referrals as part of the target. Wow; imagine if you have symptoms suggestive of a cancer and your GP would rather claim the cash for their practice than refer you for investigations. This is simply outrageous!"


"What are the implications for MSers? As part of our 'Brain Health - Time Matter in MS' policy document we highlight the long referral delays from GPs to a neurologist for patients presenting with neurological symptoms compatible with MS. These incentive schemes will simply increase this delay. We really need to oppose these schemes. I can't see who benefits from asking GPs to reduce their specialist referral rates by paying them a cash incentives, but the central NHS bean counters. What is happening to the NHS?"

"The above incentive scheme is no different to our 70:30 high-cost drug rule. Our high-cost drug prescribing is being capped based on last year's prescribing. If we under prescribe we will be given a 30% of our underprescribing as cashback by NHS England. If we over prescribe NHS England will only cover 70% of the costs and our Trust, or Hospital, will have to find the money from their existing budgets to cover the 30% shortfall. Therefore there is a cash incentive at a Trust level to encourage us to under prescribe, and a stick to stop us starting new patients on treatment. We are very concerned about this policy as it penalises new patients and any new treatments coming online. Patients started on DMTs tend to stay on treatment therefore the costs increase over time, therefore any new patients started on treatment will add to the total and we will have to get our Trust to find money to pay for the 30% penalty. As our Trust is in deficit where are they going to find the money? May be NHS England are asking us to negotiate a 30% discount with the Pharma companies who are selling these products or they are asking us to innovate. Could we badge off-label prescribing as innovation and save the NHS money that way?"


"Austerity is really putting clinicians in a very difficult position. We are meant to treat our patients based on the best evidence available. These policies are asking us to make financial decisions about referring, or not referring, prescribing high-cost DMTs, or not prescribing high-cost DMTs, to save the NHS money. Who is my primary responsibility to; my patients or the NHS? I am beginning to buy into the neoliberal conspiracy theory; the Tories want to run the NHS into the ground with the hope that we the public demand a solution. They will then propose a private funding, or insurance, solution to fund healthcare for those who can afford it. Am I wrong? Or am I am just being paranoid?"

Alex Matthews-King. A moral dilemma: GP practices offered incentives to cut urgent referrals. Pulse 1 October 2015.


Excerpts

..... Such schemes are not new – in 2012 former GPC chair Dr Laurence Buckman reported PCTs’ schemes to the GMC, declaring: ‘Taking money from patient care and pocketing it for reducing something you do is wrong.’......

..... But CCGs are now also increasingly using them to cut costs, in the shadow of a £22bn black hole in NHS finances......

..... The GPC says many of these schemes are ‘ethically questionable’ and Pulse has learned that the GMC looked into at least one of them to see if it is contrary to the guidance set out in Good Medical Practice.....

..... However, it is the inclusion of urgent cancer referrals that has caused most controversy. NHS Lambeth CCG is offering payments for practices moving towards the average 2014/15 CCG referral rate per 1,000 patients......

...... But it is the public perception of these payments to reduce referrals that is of particular concern, in the wake of the furore over NHS England’s ‘cash for diagnoses’ drive last year, whereby practices were paid £55 for each newly diagnosed case of dementia......

11 comments:

  1. The austerity orthodoxy in the UK needs to be shaken up. Moreover, GPs are being made into scapegoats for many of the government policies that we should wise up to exactly what is going on around us. The junior doctors strike - due to start today but postponed at the last minute, I am sure has made many hospital doctors realise that this is one giant propaganda machine.

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    1. The strike was abandoned allegedly because junior didn't realise that they don't get paid for the day if they don't work. Apparently they were pretty clueless about the consequences of unionism. Now factory workers would never be so gutless.

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    2. Absolute rubbish- of course junior doctors realised they wouldn't get paid. If they refused the talks with Jeremy Hunt when he withdrew the threat of imposing the changes anyway, junior doctors would have looked as if they were being militant for the sake of it.

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  2. This is pretty depressing and extremely worrying. I hope there are campaigners out there who are aware of what is going on and are or will do somethign about it. In everyday life, unless you are working in this area it is difficult to be fully aware of what is going on. Thanks for posting this. I will definitely look out for ways to help raise awareness of these issues and join any campaigns I beocme aware of. It sounds crazy.

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  3. It should only take one legal case against a GP for failing to refer a patient promptly to get this policy reversed. The problem is showing that the delayed referral, or non-referral, was due to the cash incentive not to refer. It may be difficult to make a case for MS, because so many neurologists don't consider a delay in diagnosis of MS to be a problem. Medicolegal disputes are usually settled on consensus, i.e. how does the average neurologist manages MS. I suspect very few neurologists accept 'Time is Brain' in relation to MS.

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    1. I can confirm if I was seen by a consultant neurologist much quicker than I did I would be in a much better physical and mental condition than I am today. It was a car crash of care what happened to me and it's currently with the PHSO and GMC.

      MS is not always non-urgent. Time really is brain.

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  4. Given that certain tory ministers and MPs are also current board members of PRIVATE health companies what did anyone expect?? Total conflict of interest, and this moronic obsession with 'austerity' is driving this country over the edge of a cliff. No one has stopped to wonder why this government is obsessed with cuts? Because they only want to save their own jobs and little political cliques. This idea that there is no other way is utterly wrong, there are plenty of other ways, no matter how much you cut spending it will make NO DIFFERENCE to the debt, the interest alone has long ago outstripped the ability to pay it back, and only serves to suck more money from the economy, destroying growth and expansion. Government after government has borrowed money with no intention of ever paying it back, just so they can secure votes so they have a job. The policy is deflationary and we wonder why companies all over the country are failing and real unemployment, not government massaged figures, are so high especially among the youth.

    This combined with the generational low in interest rates which is sucking more money from the economy, destroying the pensioners who were told to save for retirement, and driving the pension funds themselves to the brink is creating the perfect deflationary storm, so no matter how much QE you engage in it is never going to lead to money going where its needed creating jobs and new businesses because it never trickles down into the broader economy.

    Anyway back on topic, real investment in the NHS is needed but the myopic fools in Westminster think that the private sector will pick up the slack! which of course it wont because there is no profit in long term care for chronic brain injuries which by the very nature of MS will only get worse and need more and more clinical intervention. But hey! its only the long term sick and disabled who cares as long as my house is rising in nominal value its all AWESOME right! Lets just start another war so no one stops to ask these questions.

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    1. Love your comment.

      Brilliantly argued.

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    2. Interestingly, debt as a proportion of GDP was higher than it is now after the WW1 and reached the dizzying height of >200% in the 1940s. You can see for yourself with this link.

      http://www.ukpublicspending.co.uk/uk_national_debt_chart.html

      What got the UK to shrink its debt was growth of GDP and inflation. Why not again? At least it could save the NHS.

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    3. Anon 4:41
      That is a brilliant comment. I nearly exploded in rage when I saw the cretinous Andrew Lansley who drew up the disastrous policy change on the NHS (which wasn't even in the Tory manifesto so people certainly didn't vote for it, aided and abetted by the stupid LibDems) has quietly shuffled off to the Lords and taken up a number of lucrative positions on the boards of private health companies (his wife runs a lobbying firm that also advises private health care).
      He should be in the stocks and pelted with clinical waste.

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  5. I emailed a suggestion about patient care to my local GP surgery. I received a reply asking if I would like to join their patient participation group (PPG). So I said yes and I really hope I will I get the chance to discuss MS and hospital referrals at the group meetings.

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