Exclusive - Consortia pay levy to slash GP income

At least 15% of practice income should be top-sliced to fund quality premium payments for GP consortia, according to a leading Conservative GP.

Dr James Kingsland: 'Historically, we have invested in failure. So more money should go to successful practices' (Photograph: R Stratton)

The move could trigger a huge redistribution of GP funding and GP leaders warn it could create perverse incentives to cut referrals and prescribing.

But a leading GP adviser to the DoH backed the move as a way to force out poor practices, warning that the NHS had 'invested in failure' for too long.

The White Paper Liberating the NHS sets out plans for part of practice income to be tied to consortia's outcomes and financial management.

Consortia would be free to decide 'how best to apportion' this between member practices, the White Paper says.

Conservative Medical Society chairman Dr Paul Charlson said the figure should be large enough to act as an incentive to practices. He said that assuming QOF payments came down, a 15% levy for the quality premium would mean 30% of GP pay was performance related.

'It is not unreasonable. We would be disingenuous if we said that all GPs performed as well as others because that's not the case,' said Dr Charlson.

Dr Charlson said consortia could allocate poor practices a lower share of the quality premium. 'Some people will be worse off because they are not working as hard. It's about time: bring it on,' he said.

The DoH's GP commissioning national clinical lead for England Dr James Kingsland said he hoped top slicing would kill off poorly performing practices.

Quality premiums should reward successful practices more, he said. 'Historically, we have invested in failure in the NHS. So more money should go to successful practices.'

Dr Kingsland said that if poor practices were forced to close then so be it. 'If the unsuccessful bits start to shrink then I question their long-term viability, ' he said.

But GPC deputy chairman Dr Richard Vautrey warned a large top-slice could create perverse incentives. 'If it is a sizeable portion - and 15% would be a sizeable portion - patients may believe the doctor is only recommending a particular treatment because of a direct link to financing the practice,' he said.

Editor's blog: Is 15% of GP income too high for quality premiums to consortia?

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