King's Fund senior fellow Nick Goodwin said PCTs are using scorecards to commission services and monitor quality.
‘The DoH has made it clear that the balanced scorecard is its preferred model to commission primary care services. It seems in future a lot of primary care is going to be commissioned by PCTs looking to bypass the national contract,' he told the NHS Alliance conference in Manchester last week.
‘Initially, they're talking about using scorecards to make enhanced service payments. We may get to a point where there is no GP contract and balanced scorecards are used instead.'
The DoH is developing a national balanced scorecard, and many PCTs are performance managing practices using scorecards of their own. But Mr Goodwin warns widespread use of scorecards will lead to ‘big problems'.
‘At practice-level, it becomes a very crude tool and means practices are rated down when really they just have a difficult population.'
A DoH spokesman said there were no plans to link practice income to balanced scorecards. But a recent DoH policy document, Improving Quality in Primary Care, says PCTs ‘may want to introduce incentives' for practices based on scorecard ratings.
The King's Fund is currently seeking GPs' views on how to measure quality as part of the first phase of its 18-month inquiry into the quality of general practice in England.