This is one of 11 suggestions in NHS Confederation document Rising to the challenge: health priorities for government and the NHS.

The others are:

• Removing the MPIG,
• Reviewing seniority payments and the arrangements for paying for premises,
• Defining the expected core set of services within the contract,
• Moving to a national menu of QOF indicators that can be adapted to meet local needs,
• Improving alignment between the different contractual mechanisms for general practice and pharmacy
• Creating incentives for practices to work federally and rewards for increased scale, allowing for much more effective integration with social, community and specialist care,
• Incentives for taking greater responsibility for out-of-hours care and patients' use of emergency care services,
• Aligning the contract and regulatory mechanisms to avoid duplication (because practices are more than the sum of individual practitioners, more than just professional regulation is required)
• Allowing greater local flexibility to negotiate GP contracts, and,
• Using practice accreditation and accreditation as a basis for rewarding disease management expertise.

NHS Confederation chief executive Steve Barnett said a frank debate during the forthcoming election along with cross party co-operation afterwards, is essential if the NHS in England is to deal with the coming years.

He said: ‘The NHS has to play its part in rising to these challenges and should not be looking to government for all the answers - both clinicians and managers need to focus, among other things, on rooting out inefficiencies in the system, reducing costs and redesigning services.'

• Editors' blog: A storm gathers around the GP contract

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