GMS contract negotiations for 2012/13 are underway, and GPs believe DoH demands for an efficiency saving in 2011/12 are likely to be repeated.
Data from accountants, revealed in this week's GP, show that the decline in GP profits is already accelerating.
The BMA will submit evidence to the Doctors' and Dentists' Review Body, focusing on the 'deterioration of doctors' pay' and evidence of a decline in morale and motivation.
NHS Alliance GMS/PMS lead Dr David Jenner said it was unlikely the DoH would impose major GMS contract changes because it was 'in danger of losing most GPs over the Health Bill and pensions'.
But he said the DoH would 'undoubtedly' try to make further efficiencies. This could see QOF thresholds increase and a reduction in points for certain indicators, he said.
NHS Confederation acting deputy chief executive David Stout agreed that the DoH's focus would be on efficiency and productivity gains. 'The DoH must look at every penny of NHS spend including that in primary care. I don't expect general practice to be exempt.'
But GPC member Dr Nigel Watson warned that practices were already facing falling income and some could be forced to cut services if efficiency savings were demanded.
He said: 'Many practices are now back at the 2004 position or slightly worse than that.'
QOF quality and productivity indicators introduced last year are expected to continue into 2012/13. Dr Jenner said it was too early to assess their impact, but PCTs felt they were useful.
NICE has shortlisted 17 indicators for removal from the QOF. Dr Jenner said the depression indicator was the 'one to watch'.
Both he and Dr Watson believed practice boundaries were unlikely to be scrapped as part of the 2012/13 negotiations. Dr Jenner said: 'My guess is the government is still keen but it might slip another year.'
The DoH would not comment on whether practice boundaries would be abolished in April as initially planned, but it said it was discussing GMS contract plans with GP representatives.
