The Tories have already said that they want to rewrite the GMS contract, with an emphasis on making GPs responsible for commissioning. This could herald the end of a UK-wide deal.

What's more, as GP also reports this week, there is talk in some circles of amalgamation of PMS and GMS contracts at some point in the future.

It also seems certain that, whoever forms the next government, the QOF will become harder and, possibly, make up a smaller proportion of GP income.

Under Labour NICE is now in control of deciding which indicators should be considered for inclusion. Indicators will change annually and top thresholds look set to rise. The Tories, meanwhile, want QOF to become 'more challenging' and worth less money.

The GPC and many GPs would probably welcome a shift in income away from the QOF if this money were to be diverted into the global sum, but how likely is this?

A more realistic scenario would be that any money taken out of QOF would only be made 're-available' to GPs with strings attached - by opening on Sundays, for example, or for commissioning out-of-hours.

NHS managers and many politicians seem to view QOF as an added extra, a bonus payment scheme if you like, that can be manipulated to make GPs do what they want. But QOF was never intended to be a 'bonus' payment - it is an essential part of practices' income.

Unfortunately with all political parties intent on getting more for less, further change to the QOF that creates more work for practices is almost certain. As the NHS Alliance's Dr David Jenner suggests, perhaps the only way to avoid this is if we wake up on 7 May to find the UK has a hung parliament.