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Sharper incentives as GPs are forced into competition

GPs are to be offered 'sharper' incentives to take on new patients as part of Government plans to force practices to compete for business.

But if practices lose patients they will pay a heavier penalty, a report from the Department of Health reveals.

The regulatory impact assessment on the Our Health, Our Care, Our Say White Paper says increasing the 'marginal value' of each patient to GPs will 'facilitate increased competition' among practices.

'These proposals increase the monetary values attached to patients so practices are more strongly incentivised to keep lists open, and make themselves as attractive as possible to new and existing patients.'

The statements mark the first explicit commitment by the department to getting GPs to compete with each other,

as well as private providers, for patients.

Details would be agreed in negotiations with the GPC, the impact assessment stated, but there would be no extra money.

Cutting reliance on the MPIG and making money for infrastructure, such as premises, follow the patient were highlighted in the White Paper itself

as ways to increase incentives.

Dr Mark Hunt, a former adviser to the department and a GP in Frome, Somerset, said the idea was to put more money into the 'fixed capitation-based budget'.

He said: 'The new contract has diluted the incentive for people to take on more patients. This is trying to say instead of doing more with the same patients, get more in.'

But GPs and academics attacked the plan as dogmatic and high risk.

Dr Chaand Nagpaul, chair of the GPC service development subcommittee and a GP in Stanmore, Middlesex, said patients were 'not interested in shopping around'. He said: 'I don't think patients see practices as a commodity like Tesco or Sainsbury.'

Dr Rebecca Rosen, a GP in south London and fellow in health policy for the King's Fund, said the plan was a 'high-risk strategy'. She said: 'Without linking it to infrastructure I'd be very afraid about impacts on quality.'

The impact assessment also revealed the not-for-profit sector will be offered £25 million-worth of grants and loans to help them bid for NHS services.

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