Intended for healthcare professionals

Head To Head

Should GPs be fined for rises in avoidable emergency admissions to hospital? No

BMJ 2013; 346 doi: (Published 05 March 2013) Cite this as: BMJ 2013;346:f1391
  1. Chaand Nagpaul, general practitioner
  1. 1Stanmore, London, UK
  1. chaand.nagpaul{at}

Commissioning organisations in England face losing a quarter of the “quality premium” if they do not keep down their emergency admissions for specific conditions. Martin McShane (doi:10.1136/bmj.f1389) supports the plan, but Chaand Nagpaul worries about possible unintended consequences

Reducing avoidable emergency admissions is undoubtedly a desirable and worthy aim, not least because it will benefit patients. Additionally, emergency admissions are a considerable drain on NHS resources, representing about 65% of hospital bed days in England, at a cost of £11bn (€13bn; $17bn).1 The health data company Dr Foster estimated that 29% of these admissions are potentially avoidable and amenable to interventions in the community.2 Emergency admissions also have an adverse effect on provision of other hospital services—for example, by causing cancellation of elective operations at short notice—and Dr Foster says that overoccupancy of hospital beds is at “breaking point,” risking patient safety.2

Annual emergency hospital admissions have increased by 37% over the past 10 years.3 The NHS is required to save £20bn by 2015, and avoiding emergency admissions is a key policy to deliver this. Currently, commissioners use local referral incentive schemes to encourage general practitioners to reduce their emergency admissions. …

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