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An alternative quality framework for PMS practices is likely to contain indicators designed to reward practices for targeting 'difficult to reach' patient groups.

Dr James Kingsland, chair of the National Association for Primary Care, said rewards for providing services for homeless people, alcohol or drug misusers, asylum seekers or for teenagers with sexual health problems could replace domains such as diabetes or epilepsy.

The alternative quality framework will be discussed by a working group including the BMA, Practice Nurse Association and the NAPC at a series of meetings starting next week.

Dr Kingsland, a GP in Liverpool, said national 'signposts' could be created to suggest to practices how to measure quality in these areas.

'Rather than do the GMS quality framework, we could put some other indicators together and not collect for one or two [of the existing] clinical domains,' he said.

'With national signposting or ''pointers'' we could say here's the core research, so if you structure a programme of care in this area you can be consistent with the evidence base.'

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