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Quality pay cap to hit top earners

Practices facing the most work to hit quality targets will have their pay slash-ed to protect lower earners

under plans being considered by GP negotiators and the NHS Confederation.

A leaked Department of Health document obtained by Pulse reveals fears that massive variations in raw disease prevalence data would 'destabilise' lower-earning practices and cause staff losses.

The document says the contract-saving deal to use practice disease registers to weight quality payments would create 'too big a difference' between practices and 'unfair distribution of funds'. GPs who saw themselves as losers would feel 'let down'.

Talks are now focusing on using a complex correction factor to tackle the problem by compressing the maximum and minimum practices can earn per quality point (see table).

The formula will have the effect of capping quality earnings for practices with highest prevalence and hauling quality pay above a minimum threshold in low-prevalence areas.

GPC joint-deputy chair Dr Simon Fradd said a 'dampening mechanism' was needed to protect lower earners and the proposal was one of 'four or five options' on the table. He added: 'I can understand GPs with high prevalence saying that's unfair, but our job is to sit in the middle and we have to make a political decision.'

Dr Fradd said the relationship between prevalence and workload was 'not linear' because practices had similar set-up costs and overheads.

But GPs expressed shock at the plans, claiming they would penalise the hardest-working practices.

Dr David Reade said his Liverpool practice had high asthma prevalence and would not be rewarded for the extra work. He added: 'For doing double the work of a neighbouring practice I'll only get a small increase in money.'

GPC member Dr Fay Wilson, who led calls for prevalence-weighted quality pay to be included from the outset, said the plans would be 'very unjust' to practices with large disease registers.

Professor Martin Roland, director of the National Primary Care Research and Development Centre and a key adviser on the quality framework, said practices were already protected by MPIG.

'Assuming the quality framework is additional money then there's no reason it should not try to reflect workload as accurately as possible,' he said.

How the plan would compress practice

quality earnings (£ per point)

Raw Adjusted

Min Max Av Min Max Av

CHD 23 144 75 56 105 75

Hypertension 20 228 75 59 131 75

Diabetes 21 161 75 60 110 75

Mental health 11 365 75 54 169 75

Source: Department of Health

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