HOW would you feel if you knew your doctor's practice might be getting paid not to send you to hospital?

It might sound crazy, but this could have become reality if South Worcestershire Primary Care Trust's health bosses had been granted their wish.

Their proposed incentive scheme for GPs included the idea of paying practices if they kept their level of acute hospital referrals down.

The proposal was made because of pressure on resources.

In short, it would appear that the PCT is trying to deflect patients away from Worcestershire Royal Hospital, which is struggling to cope with its lack of beds.

The number of red alerts at the hospital during the winter showed there was a serious shortage of acute beds in the county.

While serious efforts to deal with the problem should be applauded, this ill-considered idea is simply alarming.

GPs told the trust's chiefs what they thought about the idea in no uncertain terms last week, and it was hastily scrapped.

Dr Simon Parkinson, secretary of the Worcestershire Local Medical Committee, complained that GPs were not consulted on the proposed incentive scheme.

Someone within the trust obviously spent many hours drawing up a complicated formula, deciding exactly what the admissions target for each practice would be.

After all this work, GPs rejected the idea immediately. The whole exercise was a waste of time and taxpayers' money.

But this is not the most worrying aspect of the proposed scheme.

In the document sent to GPs, the trust went to great lengths to assure doctors that the scheme was not aimed at preventing or paying them to avoid admitting patients with life-threatening conditions.

"It is about encouraging GPs to consider alternative and more appropriate care to patients when these are available outside the acute hospital setting," doctors were told.

This desperate attempt to explain the motives of the scheme is telling.

Having to say what the scheme is not is an admission that it can be interpreted in different ways, and it is obvious that GPs were not convinced.

Unsurprisingly, other GPs have claimed to be insulted by the proposal. It questions their judgement, and suggests they have been sending patients to acute hospitals without considering other options.

The idea that they need a financial incentive to reduce their acute referrals is quite bizarre.

If the scheme had been implemented, medical decisions could theoretically have been based on a practice's finances rather than a patient's health.

"One of the joys of the NHS is that GPs don't have a financial stake in your treatment," said Dr Parkinson.

"If I say you need an operation, it's because you need an operation, not because I will make money out of it."

The whole issue of avoiding acute hospital referrals reared its ugly head last December.

Worcestershire Acute Hospital Trust devised a controversial escalation policy, which urged GPs to avoid sending patients to acute hospitals when they were on red alert.

It urged GPs to find alternative ways of managing patients in the community, which provoked an angry response from doctors.

Worcester GP Jonathan Pratley was one of several doctors to dismiss the policy at the time.

"Patients don't want to go to hospital, and we don't like to send them in," he said.

"We wouldn't do it if there was an alternative, even if there were 100 spare beds."

The PCT has evidently learnt nothing from that episode, and believes GPs are sending patients to hospital for the fun of it.

With the trust's massive debts, there must surely be better ways of spending money than to reward practices for simply doing their job.

Trust bosses, including chief executive Mike Ridley and chairman David Barlow, have talked about how primary care service cutbacks were going to improve health care in the region.

However, when they try to compromise GPs in their work, urging them to make changes for financial rather than health reasons, alarm bells start ringing.

The other problem is that doctors are being told to look for alternatives to acute referral at a time when primary care services have been cut to the bare minimum.

When GPs and other primary care workers have so little faith in the trust bosses, the public is unlikely to be convinced by their claims.