July's health White Paper proposed a quality premium which could financially penalise practices if their consortium underperforms. Last week's public health White Paper is even bolder and suggests at least 15 per cent of the QOF should be dependent on public health.
Quite how much of the QOF is already public health-related, and therefore how much of a workload change this will mean for GPs is unclear, but Mr Lansley's intent isn't.
There was much debate at last month's NHS Alliance conference in Bournemouth about the proportion of GP income that the quality premium would represent and that will be for GP contract negotiators to crystallise.
One manager even suggested that the quality premium could be as high as 25 per cent of a GP's income.
This week's GP reveals that Conservative Medical Society chairman and Yorkshire dermatology GPSI Dr Paul Charlson thinks quality premiums should represent 15 per cent of GP income.
This comes at a time when the BMA and RCGP are to oppose coalition government plans to make GPs responsible for rationing treatment.
The GPC points out that having 15 per cent of GP income dependent on consortia performance risks patients believing their treatment is linked to GP pay.
Is this the price GPs will have to pay when the operating framework is published for PCT debt not to be passed to consortia? If so, it is too high and negotiators should seek to reduce it to a much lower percentage.
One thing from both health White Papers is clear: Mr Lansley has set his sights on making GPs even more accountable for their income and pay.