GPs should also expect immediate changes to the contract from next year should the Conservatives come to power, he said.

‘There is growing evidence that too much income comes from QOF,’ he told GP newspaper. A ‘floating’ value for QOF points could save cash for PCOs, he added. A limited amount of money would be available for QOF nationwide and a value for points would be assigned according to national performance.

Shadow Conservative health secretary Andrew Lansley told delegates at the NHS Confederation in Liverpool last week that GPs would have their own budgets within a year of the Tories coming to power.

Mr Edwards said that would mean completely changing the GP contract. ‘If they are committed to making GPs responsible for NHS budgets, it will have to be enforced contractually,’ he said.

As Labour and the Conservatives publicly squabbled over health service spending, conference chairman and Radio 4 broadcaster Sarah Montague said neither party’s health secretary sounded convincing.

NHS chief executive David Nicholson told delegates to start planning for cuts now and could not rule out more radical plans, like charging patients to visit A&E or their GP, or cutting non-essential services such as IVF.

Professor Chris Ham, professor of health policy at the University of Birmingham, said the idea of charging for patients was more likely under the Tories. Professor Ham noted with interest that Mr Lansley committed to all the founding principles of the NHS except ‘free at the point of delivery’.

The charges could be based on the system in New Zealand, where patients pay roughly £20 per visit, he said. The idea was ‘extremely complicated’ because it causes A&E admissions to rise and would make health inequalities worse, he said.

The NHS Confederation’s PCT Network director David Stout said the idea would be an ‘administrative nightmare’.

tom.ireland@haymarket.com

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