Paying ourselves a 'quality premium' will extinguish patient trust

Too right David

I agree wholeheartedly that the concept of a quality premium is unjustified. Surely the CCGs have a job to do and if anything there should be penalties for not doing it, rather than rewards for doing what is their job...How about all the local GPs vote each year on the quality of the CCG? Part of the whole public sector issue (not just NHS) is this 'reward for doing the job' culture at high levels.

David raises very valid points in this article.GP commissioning creates a perverse incentive to focus on financial gains rather than high-quality care. Will GPs remain the best advocates for patients or will they be running a profit-based business?

Over the decades, British general practice has adapted to change while retaining the respect of patients. GPs have clinical expertise and are also trusted to wield the pivotal power of referral.

In my view, GPs' role as advocates for their patients is compromised if they directly hold the purse strings. A service led by clinicians that is responsive to patients sounds good, but only if that prioritises clinical need and not business need. The commissioning structure being proposed is all about cash. GPs will be both purchasers and providers. This conflict of interest will inevitably tax their powers of disinterest.

It's worse than that.
The Quality Premium is to be top-sliced from CCG budgets (as I understand it): so the worst off areas will be subsidising the better off - who will then be able to perform even better in future.
As Margaret Thatecher quoted "to those that have shall be given, and from those that have not, that which they have shall be taken away".
Nothing changes in Conservative Party policy.