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Gold, incentives and meh

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Ministers are to offer GPs incentives to sign up for practice-based commissioning in a desperate bid to rescue their flagship primary care initiative.

The Government wants to force rewards for participating practices into the next version of the quality and outcomes framework after ongoing surveys revealed 90 per cent of practices have snubbed pleas to get involved.

A source close to ministers, who admitted uptake had been 'sluggish', said: 'Part of any extra incentive is about getting better information and more support but it is true that we are also looking at delivering additional incentives through QOF.'

The U-turn on rewards, designed to ensure the target of all practices commissioning by the end of 2008 is met, was signalled by health minister Lord Warner in a speech to NHS managers.

He said: 'I am looking at how we can incentivise practice-based commissioning and am also considering a stepped approach.'

Dr Mo Dewji, clinical director of primary care contracting with the department and a GP in Milton Keynes, Buckinghamshire, said a variety of incentives for commissioning were being considered 'to turn this vision into


GPs applauded the attempt to kick-start commissioning but questioned the methods the Government might use.

Dr Laurence Buckman, GPC deputy chair, said incentivising commissioning was a good idea, but argued the QOF would be 'completely distorted' if a further politically motivated bolt-on was added alongside access.

'It wouldn't work because the QOF is about evidence-based quality delivery,' he


Dr Mike Dixon, NHS Alliance chair, said: 'I can see why it might be tempting but there would be a logical argument for leaving QOF for clinical excellence.'

Dr Phil Taylor, a GP in Axminster, Devon, who is carrying out an evaluation of practice-based commissioning, said many practices would prefer upfront 'pump-priming' cash.

He predicted he would need approximately £30,000 for his nine-partner practice.

An ongoing survey conducted by the National Association of Primary Care has found only one practice in 10 is ready to commission.

A Department of Health spokesman confirmed it was 'considering what further support' would be helpful for practices.

By Rob Finch

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