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Practices should be paid via 'volume' contracts similar to those used by walk-in centres if dual registration is introduced, the BMA believes.

In its submission to the Government consultation on the upcoming community health White Paper, the association said it had no objections to dual registration. A payment by volume system would be a 'relatively simple' way of paying GPs for treating another practice's patients, it added.

But the demand has received a mixed reception from GPs, with some arguing extra baseline funding would be needed

if dual registration was introduced.

Volume payments would mean GPs merely getting a set fee for each case.

Dr Fay Wilson, secretary of a network of seven London LMCs, said the system could give GPs in the capital a 'perverse incentive' to see more people from outside the city. She said: 'It would be ironic if a dual registration system made things even worse.'

Dr Peter Fink, Manchester LMC secretary, criticised the whole idea of dual registration. He said extra out-of-hours services should be commissioned by PCTs instead. 'It seems far too complex for general practice.'

Dr George Rae, a GP in Whitley Bay, Tyneside, said volume payments had merit as long as continuity of care was not disrupted. Incentives to favour commuters over registered patients would be ignored by the ethical majority of GPs, he added.

The BMA's submission also demanded that new primary care providers should have

to do the quality and outcomes framework.

Dr Laurence Buckman, GPC deputy chair, said: 'We want to know that patients are getting the same standard of treatment wherever it is delivered.'

Other BMA suggestions included a network of 'community-based' health centres housing facilities such as diag- nostics, outreach specialist services and GPs with a special interests. These would be preferable to 'super-surgeries', it said.

Huge investment in premises would be needed to enable all GP surgeries to expand the services they provided, the submission added.

Dr Hamish Meldrum, GPC chair, said GPs were 'as eager as anyone to improve convenience and access' and were open to the idea of dual registration.

What the BMA says about:

Dual registration

· 'Should not be allowed to diminish the registered list system'

· 'Payment by volume a simple means of resourcing'

Alternative providers

· 'Must be a level playing field ­ this must extend to quality standards, including the QOF'

Super-surgeries

· 'Not effective in all circumstances'

· 'Rather than the expensive option of developing every surgery, we suggest a community-based resource'

Access

· 'Investment in primary care premises an integral component of any solution'

· 'Global sum urgently requires extra investment if practices are to expand'

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