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The Government's promise that scrutiny of GPs' quality achievement would be 'light touch' is in ruins after PCOs were ordered to take a tougher stance.

Managers are being urged to involve NHS fraudbusters if they have 'any concerns' over GPs' claims and to conduct stringent 'reality checks' to ensure they can afford to pay out.

The directives came from the NHS Counter Fraud Service and the Audit Commission in presentations at 'training events' for managers.

The Audit Commission warned PCOs to be aware they had only been given enough cash to pay out 777 points on average, far lower than most GPs' aspiration levels.

It also indicated they would not get any extra money from the Government to pay for higher achievement by GPs and they would have to find it from their own budgets.

Suggested checks on GPs include comparing achievement reports with referral and prescribing rates and searching for anomalies such as sudden changes in figures, very high or low levels of achievement or uneven entry of data.

The NHS Counter Fraud and Security Management Service told managers to involve its local officers over such 'irregularities' and also advised PCOs to scrutinise low as well as high scorers.

GPC chair Dr Hamish Meldrum said the contract limited the service's role to carrying out a random sample of 5 per cent of practices.

'It should not be routinely involved in the review of the Q&O,' he said.

GPs said extra scrutiny was inappropriate and went completely against promises of a 'light touch' approach.

Devon LMC chair Dr Peter Jolliffe said PCOs would be in for a shock if they attempted to go into such a level of

detail.

'If they try that they will spend all their time in appeals processes,' he said.

Dr John Grenville, chair of Derbyshire LMC, said he had been to meetings with PCO managers and they had been 'horrified' by the things they were being asked to do.

He said: 'They were saying ''What planet are these people on?''. Not to find the money or to artificially push down achievement would alienate the workforce.'

A spokesman for the NHS Counter Fraud Service said it may need to investigate achievement claims to 'ensure GPs get their fair share of Q&O money'.

By Ian Cameron

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