Clinical commissioners will be assessed and rewarded using the Commissioning Outcomes Framework (COF).
Responding to a consultation on potential indicators for the framework, the BMA said linking rewards to financial performance could undermine relationships with patients.
‘The BMA has grave ethical concerns about the potential for a reward based on financial performance to damage the doctor-patient relationship,’ it said.
‘A patient should never have reason to think that their doctor is making decisions based on anything other than clinical need.’
The BMA also warned that the indicators were ‘extremely detailed and prescriptive’.
‘We are concerned that such detailed indicators may promote and embed a target culture, detracting from the focus on local healthcare needs and placing a potentially overwhelming bureaucratic burden on clinical commissioning groups (CCGs) and practices,’ it said.
GPC negotiator Dr Beth McCarron-Nash said the indicators would be ‘extremely demanding’ for practices to monitor and many were inappropriate. ‘Many of the proposed indicators are outside the control of CCGs,’ she said.
‘Many relate to provider performance and not commissioning and we are concerned that CCGs could be punished for things they have no control over.’
The use of inappropriate indicators could mean CCGs covering high-need patient populations have resources withdrawn, rather than being given support to commission effectively, she said.
Professor Helen Lester, who leads the piloting of potential QOF indicators, said it was crucial that outcomes targeted by COF indicators could be linked to outcomes over which CCGs had influence.
‘Attribution is as vital for the COF as it is for the QOF,’ she said.