Hi! Wondering if anyone has any info on 'Referral Management Fees' - how GP's make money from not referring: I have very limited connectivity at the mo, and haven't bookmarked the source I found.
Some Trusts in England (maybe Wales) use Referral Management Centres - where private companies vet referrals and earn cash for blocking them.
This is linked back to my post about the distress of late or mis-diagnosis:
I should have been referred to ENT almost a decade ago according to protocol (nasal polyp) - thanks Barnclown for teaching me about them - and they would have looked into systemic illness, and maybe, just maybe, hastening my SLE diagnosis by eight years.
Thanks for being there xxx
PS Storm-damaged overhead phone line crossing three unoccupied wooded properties + BT Openreach=a day at the seaside. WOW!
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eekt
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Yes 🤦🏼♀️...this is ULTRA SPOOKY...😳😱🤯😡...and if we don’t actually know about this, how can we be ready to appeal against it? In my case, the authority involved is always referred to as “they”: DYSTOPIAN, yes?
Thanks Coco! 😘 A futuristic dystopian nightmare here and now...I'm searching for the reason I had over a dozen nose/sinus/breathing/purulence/pain GP appts over the course of eight years with no ENT referral - when anything involving one-sided symptoms like eye swelling should have been immediate, and of course to rule out malignancy - and it seems to come down to fees? What else?
Plus rash+chronic sinusitis or rash+nasal polyp will turn up systemic illness (including SLE) in a symptom checker, as every ENT knows!
Hey ho, another round of medical records retrieval (before any notes can be changed...has happened!) and I can threaten to go to the police as 'wilful neglect' is a criminal offence 😁
Thanks Coco, hope the consultation-stack-induced medical PTSD is under control and you'll soon have good outcomes! 😍 mo xxx
ps what day is your birthday ??? so we can pop some corks simultaneously! 🍾🍾🍾
Well Said 👏👏👏👏...time & again we post here describing this pattern...it’s long been our reality...most GPs just don’t seem to SEE the pattern underlying these complex recurring persistence pattern signs & symptoms 🤯 ...support groups like LUK + well informed, proactive, activist patient forums like this one + our most conscientious, determined, open-minded True Detective medics are HOPEFULY disrupting this pattern “as i tap” this reply to you now..future generations are sure to benefit
I’ve heard this before, many years ago so it’s not a new thing. It’s very scary. My GP has always been quick to refer me or to offer referral if that’s what I want so I can’t complain but I’m one of the lucky ones.
When money enters the doctor-patient relationship it's never going to turn out well, is it? I am aware of the Referral Management Centres in England - most Trusts use them. Some are run by the Trust itself and some are 'outsourced' to private companies and pay these companies to screen the referrals that GPs send in, advising them whether or not they think it is a suitable referral. As you say, one of the invidious things is that by making it a commercial transcation, with a fee attached to each referral, it may introduces incentives for certain outcomes that have nothing to do with clinical need. The Royal College of GPs has called for them to be scrapped rcgp.org.uk/about-us/news/2...
I don't know about Wales and Scotland, but I would guess that in Wales, which has generally resisted privatisation more robustly than NHS England, the clinical gatekeeper boards that have been spotlighted by Wendy's campaigning have a broadly similar role.
I haven't heard of any schemes that incentivise GPs financially for refusing to make referrals. On the face of it, this would seem to be in direct conflict with their duty to provide whatever care a patient needs. But maybe someone else knows better? x
Thanks Whisperit, the mighty Quality Outcomes Framework - digital.nhs.uk/data-and-inf... - commercialised GP practice many years ago. It's still running in England, Scotland has switched to 'peer review' ...uh-o 🤦♀️...and I think it's on the way out in Wales.
That's the payment system that 'rewards' GP's for managing chronic illness etc and famously hit the headlines with the '£60 bonus for prescribing statins'....my GP said 'let's get you on a statin' before I had cholestrol-testing....I'm 4.1 !
Holyrood dumped it because GP's were claiming 98% of available payments, when only 76% had been budgeted for!!!
There's a Googlewhack on RMF's (!) - thurrockccg.nhs.uk/about-us... on page 3 - but I found 'referral management fees' in another NHS doc still to be traced again.
Great to hear from you, hope the sleep study outcome means progress with sleep! mo xxx
On reading this I couldn't believe that GPs would allow any fee to slip through their hands. I once dealt with the GP contract and knew how it worked. At all times of initial contact the GP is responsible clinically and makes a referral as needed. Or at least, that is how it was. It seems their gatekeeper role now has another private step before a referral happens. Not unlike the insurance system in the USA. Simon Stevens , chief exec of NHS England has long been an advocate of the American system, and was special adviser in the days of Labour.
Apart from the strange notion that some centre can judge referrals, this is adding to the taxpayers bill. The centres may be similar to the old clinical commissioning groups, but they were GPs and more in charge of deciding which Trust was the right one. I just don't know.
I'm passing on this. PTSD from my old job!
I'm also jealous of anyone who gets near the sea on any day x
Yes, 'old job flashbacks' for me too! Triaging GP referrals was always tricky. Many GPs couldn't write a decent referral to save their own lives, let alone that of their patients'. The pressure to find reasons to decline was high. If a referral letter was weak, I would always ring the GP concerned and talk through the case, but some of my colleagues would simply return it with a photocopy of the referral criteria. And there's no getting away from the fact that the best - and sometimes only - way to get GPs to adopt a new initiative, or to attend training, or to help develop a new protocol was to pay them. There can't be many jobs where you are paid on top of your normal income for turning up to be trained - often in how to follow a new procedure that will pay an extra fee if you then adopt it! x
On my grumpier days I half joked that GPs would do anything if you waved a fiver at them. On better days I remembered they are self employed contractors and need to put bread on the table. They have to pay staff, overheads etc, but ......
Yes, it seems like a slippery slope to selective medical treatment, the 'deserving ill', hand-in-hand with the welfare system, which has non-doctors deciding fate when it comes to extra support for those with health conditions.
One day I'll drive by and we can go to the beach together! xxx
It is scary. I think I first heard about it from my father’s reading matter (retired doctor) and was appalled. He is one of the victims of this scheme which makes me so angry.
“From a patient perspective, it means GPs are paid to not look after them. It’s a serious dereliction of duty, influenced by CCGs trying to balance their books.”
My old island practice was mostly pretty good but one of the most senior partners also sat on the area health board as clinical chair.
He finally became too disillusioned and now sticks to being senior partner GP. It was the only independent practice in the whole archipelago area and I once attended a talk he gave about life as a GP.
He spoke of all the paper work and having to run it as a business often conflicting with the job he loved and had signed up to. Whenever I saw him (very often towards the end of my decades there) he was always very straight with me about his reasons for refusing to refer. He said that if he referred me for reasons deemed too woolly his referral would be bounced back by the consultant. Too many of these bounce backs would lead to him not being trusted by the hospital department and could well compromise the patient who had really clear need and reasons for referral. The referrals I struggled to extract were neurology and dermatology - had to go to another GP for both! Now, years on, I’m under both permanently.
Since leaving this practice 3 years ago for a new life on the mainland - I’ve relocated several times before settling where I live now. This meant joining 2 further practices before the present one.
The first would only refer very reluctantly - but I extracted a referral to urology, neurology and oral medicine out of them over this six month period. I really wanted to be sent to ENT but they refused. Urology was a one off due to haematuria.
I didn’t like this gleaming practice much at all and had to leave after six months. I made a formal complaint about one locum/ part timer just after I’d left.
Next one was very shabby - the posher new practice was turning away new patients so I had to join this one. The young GP had been seconded and was very nosy about my reasons for moving about, leaving island etc.
But she referred me to gynae, rheumy, endo and for urgent colonoscopy without blinking and was always very frank with me about her reasoning. I was only there for six months. I wrote her a letter of thanks when I left.
Take 3: my new practice seem to love making referrals rather than have to address things themselves?! I continued to be bounced back by ENT over nose bleeds and tinnitus - until finally struck gold with a referral this year to a consultant ENT who is a balance expert. Mind you I’ve never received a follow up appointment as promised because he’s away a lot apparently - very sought after.
I make monthly appointments at reception to see my favourite GP - who only works part time - just as I’m leaving the latest appointment . We seem to get on very well and I check with her that this is a good idea. Although I have to say she is everyone’s favourite. Maybe she copes better than some by being a very part time partner who also works in the hospital’s breast clinic?
So I just wanted to say - to me it sounds as if your practice is very beleaguered/ burnt out - if good GPs always leave? Many practices in Scotland are closing due to lack of permanent posts for younger GPs and over reliance on locums - who cost more and are not obviously as committed to the practice or its patient community.
I have an old GP friend who now works for the locum bank as she likes her freedom to travel and had a bad experience as a partner GP elsewhere. My husband, at a much lower level, is doing the same thing now by leaving his contracted council job for agency work. It’s better paid but the service users don’t get the continuity of care they often need and he won’t have stuff like pension, paid holidays or sick pay. But he needs more flexibility over and above the other things and he didn’t actually get any choice over when he had his holidays and was shafted over sick pay and compassionate leave.
This isn’t how anyone actually wants things to be but due to the huge additional work load pressures on GPs - who have to run practices as independent business as well as looking after patients - it’s never going to be good. As Mike/ Whisperit points out there is a fundamental conflict of interest when money comes into the equation. Same with councils who would rather pay agency workers and not have to pay the employee what their qualifications and experience are really worth.
I think, on all levels ie from GPs through to consultants, it’s honest conversation/ transparency we require from our health care providers now about the real reasons underlying their decisions. It’s the lack of transparency, starting right at the very top, that most bothers me these days. My conspiracy theorist tendencies are running riot! X
Just saw this post eekt, getting incentives NOT to refer patients is asking for trouble & disgusts me. You should have the right to see a decent Specialist & if they appear to have no interest/understanding of your medical problem you should be able to see another specialist & so on until you find the one that is interested in your medical conditions & does know & is interested in the symptoms you get
& in helping you however they are able to. This may mean keeping your symptoms at a low level or even going into remission.
"The UK’s Quality and Outcomes Framework (QOF) is the world’s largest pay-for-performance scheme in primary care."
"Moreover, the QOF does not incentivise practices to improve care for patients with the most complex needs in primary care, because these are more likely to be excepted from the scheme."
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