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'Patients will suffer as GPs chase cash'

The new contract will create a two-tier service as GPs focus their clinical efforts on illnesses covered by the quality framework, leaving other patients to lose out, GPs have warned.

Patients with musculoskeletal disorders, progressive neurological diseases, gastrointestinal conditions and dermato- logical complaints are among those whose care could suffer as GPs strive to reach target payments for quality markers in 11 clinical areas.

Dr Eugene Hughes, a GP on the Isle of Wight and a member of Primary Care Diabetes Europe, said GPs would concentrate on conditions in the quality framework that make them more money.

He said: 'GPs will mobilise themselves to meet the standards in the quality framework, perhaps to the detriment of other conditions. When you work in an under-funded service you become quite good at going after pots of money up for grabs.'

Dr John Haughney, a GP in East Kilbride and chair of the General Practice Airways Group, said patients with conditions such as rheumatoid arthritis or migraine could miss out unless safeguards were put in place. He said: 'I am confident my fellow GPs are not driven by money alone and do want the very best for patients. But if certain conditions are incentivised, I would want to make sure others don't fall by the wayside.'

Dr Henry Smithson, a GP in Escrick, North Yorkshire, who has an interest in epilepsy, said the contract may push GPs to specialise in conditions in the quality framework. He said: 'I would hope we continue to provide a high-quality service rather than being mini-specialists in conditions earmarked by the Government.'

Dr Tony Snell, co-deputy chair of the NHS Confederation core negotiating team, dismissed the idea the contract would create a two-tier service as a 'false premise'.

He said: 'Why should GPs provide inferior standards of care because other disease areas are given higher public expression in the new contract? There is nothing in the new contract saying stop offering a high-quality service.'

But Professor Ian Watt, professor of primary and community care at the University of York and an expert in evidence-based medicine, said there was evidence to prove the concerns were 'well founded'.

Professor Watt, a GP in Catterick, North Yorkshire, said: 'You have to be careful

to avoid the knock-on effect created by perverse incentives.'

The 11 clinical areas in the quality framework will be: coronary heart disease, left ventricular dysfunction, stroke and TIA, hypertension, peripheral vascular disease, diabetes, epilepsy, hypothyroid-ism, mental health, asthma and COPD.

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