The NHS Alliance report Whose NHS Is It Anyway? calls for practices' responsiveness to patient groups to be measured in the QOF and monitored by the Care Quality Commission (CQC).

As GP groups prepare to take over commissioning, the report recommends elected boards work with clinicians 'along the lines of parent governors in schools'.

Earl Howe, speaking at the launch of the report in the House of Lords last month, agreed with many of the its recommendations.

'The patient voice has to be bound into the design of services and into alert systems,' he said.

Brian Fisher, patient and public involvement lead at the NHS Alliance, said that there was a 'serious gap' between GPs and patient groups, such as local involvement networks (LINKs). 'We'd like GPs to have an obligation, or for it to be as easy as possible, to work with LINKs. The QOF could be manipulated to include patient care as defined by their patients,' he said.

'We would like to explore the democratic election of commissioning boards.'

The report calls for QOF points to reward 'responsiveness in areas other than merely access', and more detailed measures of patient experience.

It says the CQC should 'demand evidence' that commissioners and providers have taken on board patients' views.

GPC deputy chairman Dr Richard Vautrey said it would be 'difficult to unpick needs and wants' if GPs were forced to respond to patient groups.