A US pilot sent to shoot down a UFO on a dark night in East Anglia some 50 years ago only to find nothing but, well, dark night, recalled in Monday's Guardian that it 'was like being a one-legged man sent into an ass-kicking contest'.

That may be how health chiefs feel defending a policy of paying GPs not to refer patients to hospital. This is the story as told by the Sundays and picked up on Monday:

Oxfordshire primary care trust offered to pay GPs up to£10,000 to set aside time to review their referral decisions and another£10,000 if they cut referrals to below a set target.

The Sunday Telegraph gave us Royal Nuffield Orthopaedic Hospital consultant surgeon Stephen Cannon reporting the case of a young man whose referral to hospital was delayed. He had knee cancer and ended up with his leg amputated.

Was that because the GP was paid£4.50 for referring him to physiotherapy? That is left hazy.

And why the Oxfordshire PCT is facing such huge rises in referrals is scarcely touched on.

Finally, what is the estimated cost of unnecessary hospital admissions? The issue goes unexplored.

Alternatives to hospital

No, there is just Oxfordshire PCT director of commissioning Alan Webb saying the idea is to encourage GPs to explore whether there are alternatives. "We are not paying GPs not to refer patients," he said.

The Mail on Sunday linked GPs' income with payments for hitting targets on hospital referrals, alleging a "direct incentive" to limit treatment.

"Morally dubious, ethically disturbing and quite wrong," thundered Laurence Buckman, of the British Medical Association's GPs committee.

Bet the tabloids are out there tracking down a one-legged man who once saw a physio. And the health chiefs will be in an ass-kicking contest where they didn't set the rules and so don't have a leg to stand on.

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