DH clinical commissioning network lead for England Dr James Kingsland said quality premium cash may be used to extend services in general practice, but is unlikely to be allowed to boost practice profits. Sums involved are likely to be 'attractive', but too small to 'change the outlook of a practice', he added.

Dr Kingsland also said that proposals to drive integration between practices through changes to GP contracts could put personalised care and innovation in practices at risk.

Detail on how the premium will work and where the funding would come from has been limited since the White Paper Liberating the NHS was published in July 2010.

But Dr Kingsland told GP the payment would be 'linked to the mandate the secretary of state gives to the NHS Commissioning Board about the focus of care around the five domains of the outcomes framework'.

'If CCGs deliver against some targets, there'll be some premium that goes to reward that, so you can invest more in the efficient redesign you've achieved.'

He admitted there was a 'difficult debate' about whether handing additional funding to CCGs that hit targets and denying it to those that were falling behind could widen gaps between them.

But he said: 'My experience of general practice is that for too long we've had perverse incentives to fail. Sometimes failure has always attracted investment. Is that the way we want to enact these reforms, to invest in failing systems?' He added that although GP contracts would change to reflect GPs' role in commissioning, practice and commissioning funding must remain separate. Getting the reforms right was the biggest challenge for GPs in his time in the profession, he said.

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