GPs could face fee if patients use A&E
The move – aimed at giving GPs an incentive to provide longer opening hours while reducing inappropriate use of casualty and minor injury departments – is being considered as part of Lord Darzi’s “next steps” National Health Service review, due for publication in the summer.
The Department of Health confirmed yesterday that it had commissioned the NHS Confederation and NHS Employers to examine how a tariff, or fixed price, might be introduced for visits to walk-in centres, minor injury units, and for treating temporary residents. A draft report from the two bodies was being examined, it said, after the Health Service Journal disclosed the proposal.
David Stout, director of the confederation’s primary care trust network, said GPs were paid to look after patients on their registers, but when alternative services such as walk-in centres were created “arguably that duplicates what general practice is already being paid for, so we end up paying for it twice”.
NHS Employers have examined the system in New Zealand. Chris Ham, professor of health services management at Birmingham university, says patients there are charged for each GP visit, but the government can claw back money from family doctors if patients use other facilities, such as casualty departments, for what should be primary care.
The double incentive – that GPs lose both a consultation fee and face a clawback if patients go elsewhere – “means that it is very easy to get to see a GP on the same day or the next day. GPs are open for quite long hours, as they lose money if patients go elsewhere”.
Dr Laurence Buckman, chairman of the British Medical Association’s family doctors’ committee, attacked the idea as unworkable. “Charging back costs if patients went to A&E; or elsewhere would not be an incentive, it would be a punishment and work as a disincentive [for family doctors] to work in areas with high A&E; use.”
Dr Michael Dixon, chairman of the NHS Alliance, a primary care grouping, said the idea might work where GPs held budgets, were responsible for commissioning care, and could thus shape services.
Applied in other cases, the risk was that funding for the most important part of general practice – handling chronic disease and long standing illnesses – could be cut if penalty payments were imposed where “worried well” patients, or those with very minor conditions used other facilities inappropriately.
Meanwhile, with political and health service opposition to the idea of “polyclinics” rising, the NHS Confederation has called for calm in the debate. Polyclinics would group GPs around facilities that could include X-ray, blood tests and other “one-stop shop” facilities, while bringing more out-patient and antenatal work out of hospitals. They have led, however, to fears that patients would have to travel farther to see a GP.