The ferret has just found of one PCT that is sinking to new unethical depths in the incentivisation of medicine, it certainly would not surprise me if more than one PCT was indulging in this depraved behaviour. The national media has already noticed the unethical incentives offered by numerous PCTs in trying to get GPs to refer less to hospitals, clinical need is being thrown out of the window as the bean counters take over the NHS. In a new PBC scheme in one PCT the following are allegedly 'indicators of access to personalised and effective care', and GPs are being paid to reduce emergency beds, emergency admissions, out-patient referrals and alcohol related admissions, while they are being paid to let more patients die at home. These are the PCT's 'vital signs' that it intends to pay GPs for fiddling, amazingly the fools at Torbay have left the full document on their website, it may not be there for too much longer:-Emergency bed days per 1000 patients
-Admissions for ambulatory case sensitive conditions per 1,000 patients
-Proportion of all deaths that occur at home
-GP referrals per 1,000 patients
-Rates of admission for alcohol related harm per 1,000 patients
(note- ACS conditions include life threatening problems such as angina, COPD, gangrene, perforated or bleeding ulcer, asthma and many more killers)
I find it hard to comment on this scheme without swearing but I shall nonetheless try. PCTs have already unethically started schemes up and down the country that reward GPs for reducing referrals, irrelevant of clinical need. The Mail calls the PCTs 'sick' and I am inclined to agree with them on this. The new incentivised vital signs detailed above reward GPs financially for reducing referrals irrelevant of clinical need, for reducing hospital admissions for life threatening conditions and for ensuring that more patients die at home. This is not just unethical, I think the PCTs are encouraging GPs to break the GMC's clear guidance on the duties of a doctor, there could be severe consequences for both the PCTs and the GPs if they accept these sick schemes:
"-You must make sure that your conduct at all times justifies your patients’ trust in you and the public’s trust in the profession.
-You must act in your patients’ best interests when making referrals and when providing or arranging treatment or care. You must not ask for or accept any inducement, gift or hospitality which may affect or be seen to affect the way you prescribe for, treat or refer patients. You must not offer such inducements to colleagues."
-You must act in your patients’ best interests when making referrals and when providing or arranging treatment or care. You must not ask for or accept any inducement, gift or hospitality which may affect or be seen to affect the way you prescribe for, treat or refer patients. You must not offer such inducements to colleagues."
These PCT schemes are an utter disgrace. They demonstrate that the health service is being run by bean counters who have no understanding of the role and responsibility of being a doctor. Any doctor taking part in these schemes should be ashamed and could well be in grave trouble with the GMC, interestingly I wonder whether anyone with a medical degree has been involved in coming up with these ideas at the DoH or in the SHAs? It does emphasise the way in which doctors can be accountable for taking part in sick schemes like this, while medical managers are seemingly immune from ethics and codes of conduct, they can encourage bad clinical practice and they just don't care for the potential consequences in terms of patient harm.
