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New contract levers for practices to 'incentivise GPs as providers'

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Future general practice funding could be calculated according to the percentage of patients diagnosed correctly or provided with home-based care rather than care in hospital.

NHS England is set to develop and review contract 
levers for practices to 'ensure maximum benefits are achieved through rewarding quality services and better outcomes for patients'. This will involve looking at how NICE quality standards relating to aspects of primary care can be used to 'incentivise GPs as providers', according to proposals outlined in Putting Patients First The NHS England Business Plan for 2013/14-2015/16.

NHS medical director Professor Sir Bruce Keogh said he wanted to 'explore' how differential payments could be used to tackle variation in the quality of care provided by GP practices.

However, Wendy Fairhurst (pictured), chair of the RCN's advanced nurse practitioner forum and a nurse partner in Lancashire, warned this could result in 'tick box activity' rather than improve care.

'In many respects, performance measures in the guise of the QOF have led to an improvement in some aspects of care and a reduction in the variability of primary care,' she said.

'However, the concern is that these moves would lead to more target-driven, tick box activity - something which it was found contributed to the problems in Mid Staffordshire. There is a need to guard against the unintended consequences of moves such as this.'

GPC deputy chair Dr Richard Vautrey said that any action to withhold GP funding could have serious consequences for practices.

'It is deeply concerning how little those in key roles in NHS England seem to understand about general practice,' he said. 'Proposals like this could set in train changes that would significantly undermine our service that is so valued by patients.'

Earlier this month, ministers imposed a revised GMS contract on practices, involving a significant overhaul of the QOF; organisational indicators worth £20,000 per practice were scrapped and 12 new clinical indicators introduced.

NHS England's business plan also involves establishing a Primary Care Patient Safety Board and a 'comprehensive primary care patient safety strategy that will feed into the overall primary care strategy'.

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