Report in the Sunday Telegraph
"Dozens of incentive schemes have been uncovered which allow GPs to profit by slashing the number of patients they refer for hospital care.
Under one scheme, GPs stand to gain £59 for every patient not referred to hospital, if they cut an average referral rate by between two and eight per cent.
Torbay care trust in Devon will pay up to £15,000 to the average-sized GP practice if it hits a swathe of targets, including reducing hospital referrals.
NHS managers say referral rates, which rose 16 per cent nationwide during the first quarter of this year, have to be cut to save money. They claim many patients can receive equally good care from community NHS staff, such as physiotherapists and nurses.
But critics fear that patients could suffer if GPs' decisions are swayed by the prospect of a cash bonus.
A leading surgeon said that patients' cancers had already gone undiagnosed after they were denied specialist care under two such "referral management" schemes.
Orthopaedic surgeon Stephen Cannon, former president of the British Orthopaedic Association and a consultant surgeon at the Royal National Orthopaedic Hospital, described the cases as an "absolutely terrible" warning that decisions by non-specialist doctors could have devastating consequences.
He said: "I recently encountered two cases in which patients referred to physiotherapists later turned out to have a malignant tumour. If they had been sent to a consultant the outcome may have been very different.
"In one case a young man was referred to a physiotherapist because of sudden knee pain. Had he come to a specialist the symptoms should have been recognised and he should have been urgently referred to an oncologist. In this case, after the delays, the outcome was amputation. It was devastating for the patient and his family."
Dozens of practices across London, Essex, Oxfordshire, Devon and Wiltshire have signed up for schemes which pay GPs up to £4.50 for every patient on their list if they hit targets, including a target to reduce the proportion of patients they send to hospital.
The average family doctor, with a patient list of about 2,000 patients, stands to make between £6,000 and £9,000 if they achieve all the targets, on top of a performance-related pay system which already gives the average GP an income of £110,000."