Commissioners currently pay a fixed price for procedures covered by the tariff system. But a senior NHS manager said it could change to allow GPs in deprived or rural areas to pay a premium to attract providers.
Mike Farrar, the West Yorkshire SHA chief executive, who is thought to be a leading contender for the permanent position of NHS chief executive, said the NHS could create financial leeway for this by cutting standard tariffs for hospital procedures by about 2 per cent.
This would leave commissioners with a contingency fund to top up tariffs for services when required, he said. Commissioners in areas that did not need to pay a premium for services could make extra savings.
Mr Farrar said: 'Once the tariff beds in over the next three to five years, we should think about giving local commissioners more flexibility to set prices.
'It might be possible to use the price mechanism to support tackling health inequalities.'
He said it would be up to local commissioners to decide which services, if any, they paid a premium for. However, GPs said such a scheme was likely to create further instability.
GPC chairman Dr Hamish Meldrum said that it was premature to talk about changes to the tariff system and was concerned about what effects cutting the overall budget paid to providers by 2 per cent would have on them.
Health minister Lord Warner said that he thought the system would be better if there was an independent element involved in setting or varying the tariff.