GPs face potentially dramatic curbs on their freedom to send patients to hospital, with many PCTs in England told to cut their outpatient referrals by 10% or more.

Rising numbers of GP referrals have already led trusts to scrutinise their hospital activity closely, but those with high levels of referrals will now be named and shamed as the NHS publishes performance league tables for the first time.

The influential NHS Institute for Innovation and Improvement has calculated the number of outpatient referrals each PCT ought to have, based on the age, sex and needs of its local population, and found most need to reduce their rates substantially.

The average PCT had a referral rate 9.2% above the calculated ideal level in the quarter two figures for 2008/9, but in some areas rates were 50% higher than expected or more.

The worst performer was NHS Berkshire East, with referrals more than 61% above target, although it claimed it had already begun to use practice-based commissioning to curb referral increases.

Norma Southwood, an associate at the NHS Institute for Innovation and Improvement, said the tables would allow PCTs to compare themselves and had identified best practice in high-performing trusts.

‘This is designed to be a prompt for further analysis at trusts. It links in with other work going on at the institute, with the potential to move some activity from the acute sector into the community,’ she said.

Advice accompanying the publication of the tables outlined ‘key steps’ to achieve more efficient outpatient services, including incentivising GPs to reduce referral rates – directly contradicting official GPC advice on referral incentive schemes.

‘PCTs should introduce systems to monitor GP referral rates and provide feedback to them. PBC can be used to incentivise GPs to reduce referral levels where they are overly high,’ it said.

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