Apparently the Department of Health guidance for PCTs and practices on PBC for 2008-9 states that PCTs should focus on a locally agreed incentive scheme. Specifically for 2008-9 schemes should:
“… include incentivising practice based commissioners to reduce people’s lifestyle risks. However, PCTs should ensure that this does not involve ‘double paying’ – i.e. over-rewarding activities that are already financially incentivised through other means such as the Quality and Outcomes Framework. Also, incentive schemes should be cash releasing, and funded from savings made from PBC.”
I'm not sure exactly what all of this means but at least one PCT is now proposing to reward GPs financially for reducing referrals to hospital, irrelevant of clinical need, for reducing hospital admissions for life threatening conditions and for ensuring that more patients die at home.
Some have questioned if this incentive scheme fits in with the doctors ethical guidelines to act in their patients’ best interests when making referrals and when providing or arranging treatment or care. Doctors must not ask for or accept any inducement, gift or hospitality which may affect or be seen to affect the way they prescribe for, treat or refer patients. So how does being paid a bonus to keep people out of hospital fit in there?
Torbay PCT is offering GP's a bonus payment linked to achievement of a points scheme. A total of 135 points are available for achieving all targets, at the maximum level. Practices with a list size of 5891 (national average) will receive a payment of £110/point. Increasing the number of patients that die at home by 4% over last year is worth 12 points. A similar reduction in rates of admission for alcohol related harm per 1,000 patients will get another 12 points. The bean counters that run the PCT's have worked out it's cheaper to pay GPs not to send people to hospital than it is to admit sick or dying patients.
A coldly financial assessment therefore of a chronic alcoholic with liver failure would send that person home to die rather than admit them to a hospital? This would of course be a double win since it would be in both the die at home and reduce alcohol related admissions categories. Under these guidelines would Harold Shipman be an ideal GP? He had loads of patient die at home without clogging up valuable hospital beds.
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