The quality framework could become compulsory from 2010 and generate a lower proportion of GP pay, a GMS contract negotiator for NHS Employers has predicted.
Non-clinical indicators could be removed and the framework used increasingly as a performance management tool - with the worst performing GPs losing their contracts, said Dr Adrian Jacobs.
'The quality framework delivering up to a third of GPs' income is unsustainable - it will surely fall,' he told GP.
Setting out his vision of how the GMS contract would look beyond 2010, Dr Jacobs said at the NHS Employers conference in Birmingham last week that up to 30 per cent of quality indicators could be chosen locally.
Frameworks in the four UK countries would look radically different, he predicted, in contrast with comments from national clinical director for primary care Dr David Colin-Thome that variation would be minimal.
Making clear he was expressing his own views, not NHS Employers' policy, Dr Jacobs said: 'It will have to change. National solutions are often based on inner city problems. There will be PCTs who will want to go beyond the national framework.'
Dr Jacobs also said the DoH's recent consultation on the quality framework would mean ind-icators would be reviewed constantly and 'time-limited'.
'When an indicator has achieved its objective, it drops out into normal clinical practice,' he said.
GPC deputy chairman Dr Richard Vautrey said the quality framework should not be compulsory, but he agreed that quality pay would fall as investment in the global sum rose.
'I do not think it will become compulsory. Virtually every practice does it anyway. But PCTs are increasingly using it as one of a number of measures of performance. I do not think the quality framework on its own is a complete measure of practice activity,' Dr Vautrey said.
He also rejected the move towards local variations in the quality framework.
'The quality framework at the moment is full of indicators that are pertinent to everyone, whether you live in England or Scotland or wherever. We do not want to have a postcode system of provision of care.'
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