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 are 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 warned that 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.
Mr Goodwin said the national scorecard was likely to contain about 85 indicators, on factors such as QOF, access, prescribing and patient-reported outcomes.
GPC negotiator Dr Chaand Nagpaul said the idea of scorecards replacing the contract was 'far-fetched', but the 'mushrooming' use of balanced scorecards was a concern.
'It will be a highly erroneous way to commission services. We know practices vary hugely within a PCT and scorecards do not compare like with like.'
The King's Fund is currently seeking the views of GPs on how to measure quality as part of the first phase of its 18-month inquiry into the quality of general practice in England.
