The DoH's latest five year plan NHS 2010-15: From Good to Great also says QOF needs 'significant reform' to make it tougher.

The Doctors' and Dentists' Review Body (DDRB) and NHS Employers may be asked to consider even more demanding efficiency requirements for GP practices, the document says.   

QOF will remain unchanged in 2010/11 due to pandemic flu workload, but beyond then performance thresholds will be raised to squeeze more from GPs.  

Launching the document in London today, health secretary Andy Burnham said the plans were 'gritty and realistic', and would focus minds on preventing illness and 'patient-centred' care.

At the heart of the new strategy is a change in tariff payments, shifting hospital incentives towards patient satisfaction and moving services closer to home. Up to 10% of hospital income may be linked to patient satisfaction, said Mr Burnham.

Mr Burnham also raised the possibility of the best acute trusts expanding to provide community and even GP services.

He also said that a statement would be made soon on how the government plans to scrap practice boundaries - a policy the GPC feels is unworkable without great expense.

Mr Burnham revealed that the NHS will receive inflationary uplifts for the next three years, paid for by a 0.5% rise in national insurance.

Dr Hamish Meldrum, BMA chairman, said: 'The repeated talk of ‘pay restraint' when what is really meant is no pay rise at all, is demoralising. While healthcare workers clearly understand the financial pressures on the NHS, and will want to act responsibly, they should not be punished for a situation which is not of their making.

'Doctors have been highly critical of the increasing commercialisation of healthcare, so it is good to hear again from Mr Burnham that the NHS is the ‘preferred provider'. However, the private sector has a firm foot-hold, and many examples of waste and inefficiency resulting from the market model remain in the system. Restoring the NHS to a publicly provided service, where providers are encouraged to co-operate rather than compete, must be beneficial to taxpayers as well as patients.'