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Primary care organisations are planning to dock quality pay from high-

referring GPs after consultants complained of a 'mammoth increase' in workload since the start of the new contract.

NHS managers said they would challenge GPs to defend referral rates during quality visits. Practices believed to have over-referred to maximise their score would see their achievement cut.

The threat came amid furious GP attacks on PCOs for heavy-handed and 'vindictive' scrutiny, with one GP complaining he felt as if he was being accused of fraud.

It also sparked a bitter row between the GPC and the NHS Confederation's former chief negotiator on the quality framework.

Dr Tony Snell, now medical director of Birmingham and the Black Country strategic health authority, led the call for PCOs to use a clause in the contract to deny GPs quality pay if they had over-referred. He added that consultants could be given the money stripped from GPs.

'Consultants are saying, "this isn't right, we are doing GPs' work, we want quality payments'',' he said. 'Instead of giving practices the quality money, PCTs may give it to the trust which gets too many referrals.'

Heart of Birmingham and South Birmingham PCTs said they would be checking for inappropriate referrals.

Dr Snell said the GPC had agreed to allow over-referring practices to be docked points.

But GPC negotiators attacked Dr Snell for 'inappropriate name calling'.

GPC deputy-chair Dr Laurence Buckman said: 'I think we need more facts before bandying criticisms around.'

Meanwhile, Nottingham LMC has demanded an apology from Nottingham City PCT after it ordered an 'emergency meeting' with a GP who was achieving high blood pressure control scores.

Dr Ian Sklar said he felt he was being accused of fraud after the trust queried how he could have achieved 95 per cent control for the CHD6 indicator in the framework.

He said: 'I take great exception as it is a serious charge which strikes at the heart of my professional reputation.'

Dr Ian Trimble, PEC chair at the trust, said it was doing what 'all other PCTs should be doing' by checking for QMAS data anomalies.

Dr Buckman said investigating so early was 'persecutory' and the PCT had been 'vindictive and inappropriate'.

By Pulse Reporters

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