NICE said its QOF review committee would consider calls in Professor Sir Michael Marmot's Fair Society, Healthy Lives review for indicator thresholds to be raised to provide '100 per cent coverage' and reduce health inequalities.

But GP leaders said they opposed dropping upper limits for QOF indicators. The thresholds were put in place to protect patients, GPC deputy chairman Dr Richard Vautrey said.

'Not all patients can or should be treated in line with guidance or pushed to outcome levels that are inappropriate or unsafe for them,' he said. 'You can never say 100 per cent in medicine.'

RCGP chairman Professor Steve Field said the college was keen to examine the review's suggestions further.

'Now that the Marmot Review has highlighted this issue, we'd want to look at what this section alludes to,' he said. 'We'd be interested to look at evidence submitted as we are aware of research that suggests QOF is starting to narrow the inequality divide.'

Wiltshire GP and QOF expert Dr Gavin Jamie said raising upper thresholds was 'not a bad idea' but that the move raised many practical problems.

Unless the number of points per indicator was changed, raising upper thresholds would cut the incentive per patient, Dr Jamie said.

But he added that any increase in points would increase costs for the government.

NICE's QOF review committee examined upper indicator thresholds last summer. It suggested that raising them may increase health inequalities because practices in deprived areas would struggle to reach higher achievement levels and may lose funding.

Given the financial implications to practices, the commit-tee concluded that threshold decisions were best decided in negotiation between NHS Employers and the GPC.

The Marmot Review estimated that 200,000 premature deaths each year could be prevented by reducing social inequalities. Authors said these disparities cost the NHS more than £5.5 billion per year.