GPs have admitted accepting top scores in the quality framework as low as 900.
The impact will be to reduce average income in 2006/7 in those practices by over £12,000.
Difficulties in meeting mental health targets are driving the inertia. GPs do not see a reward of 23 points for the mental health review and three points for following up DNAs as sufficient.
‘A lot of practices including my own are struggling with the complexities of the mental health indicators,’ said GPC member and Sheffield GP Dr Trefor Roscoe.
Thirty-nine points are attached to the mental health domain of the quality framework.
Practices that achieved maximum points in 2005/6 are expecting a total of 950 this year. Other practices are looking at a drop of 50 to 150 points.
Although difficulties with the mental health domain accounts for most of the points gap, practices have seen achievements in hypertension control drop.
Ipswich GP Dr Sally Whale said that her practice refuses to collect ethnicity information even though 15 per cent of her practice’s patient list was born outside the UK.
‘There has also been a problem with our retinal screening system locally but we have coded our patients as under the care of a retinal screener,’ she said.
Some practices may also miss out on obtaining smoking histories. Dr Roscoe cautioned: ‘Some people see not obtaining 1,000 points as a pay cut. But anything above 750 points is a bonus for working hard.’
A spokesman for the DoH said: ‘There is no reason to believe levels of practice involvement and effort will be any different this year. All parts of the quality framework were agreed with the profession and we believe this year’s framework will have as great an impact as ever in driving forward improvements in services for patients and ensuring GPs are rewarded.’