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Blow 1

GPs told to spend 40% of quality pay on patient care

The Government expects GPs to plough at least 40 per cent of their quality pay back into their practices to improve patient services, writes Rob Finch.

GPs reacted with outrage to the demand, retorting that it was 'none of the Government's business' how they spent their hard-won pay rise.

GPC chair Dr Hamish Meldrum promised to back any practice that runs into conflict with its PCO over a failure to invest 40 per cent of quality income in equipment, staff and other patient services.

The row broke out after Chris Town, chair of the NHS Confederation's contract negotiating team, warned GPs: 'I would remind people that the quality and outcomes framework was not expected to be all profit. It was always intended to be 60 per cent profit and 40 per cent investment.'

Mr Town's statement was prompted by growing confusion over the limits on GPs' right to maximise quality pay by exception reporting services that are unavailable in their PCO and have not previously been funded by practices.

The contract guidance says only 'investigative or secondary care services' can be exeption reported as unavailable.

But the Department of Health's failure to rule where the boundary lies between primary and secondary care services has provoked fears of widespread conflict between GPs and PCOs.

Mr Town said PCOs should apply a degree of 'reasonability' in defining the boundary ­ but suggested they could use the 60:40 principle as a rule of thumb to decide which unavailable services practices must fund rather than exception report.

'It would be a hard argument to sustain the position "we're not going to do it" if a piece of kit costs £250.'

He admitted spirometry was a 'grey area', stating that larger practices should buy the equipment and singlehanders should consider clubbing together with neighbours.

Dr Meldrum said: 'It's the practice's money. It's not for PCTs to advise GPs how to

invest.'

Dr Harry Yoxall, Somerset LMC secretary, said it was 'inevitable' PCOs would use the 60:40 rule of thumb to exert pressure on practices. 'I would be unhappy if PCTs say you have to demonstrate that you have invested X ­ it's none of their business frankly.'

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