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CAMHS won't see you now

whyilove..working at Holloway prison

The Government wants to raise the bar for quality achievement dramatically to make it far harder for GPs to earn near-maximum scores.

Ministers are demanding the cost-cutting move because GPs have 'over-delivered' on the quality framework this year, leaving a £120 million hole in NHS budgets.

New disease areas, raising the thresholds GPs must hit to score points and removing 'easy' organisational and clinical indicators are all on the table in the review of the framework.

Commenting on the review for the first time, GPC chair Dr Hamish Meldrum said he believed the Department of Health intended to push through 'changes to the Q&O in terms of making it harder to make the money'.

He said: 'You won't be surprised to hear we won't want the work of GPs to be devalued. GPs should not be paid any less for doing the work in the future than they are now.'

Dr Chris Town, chair of NHS Employers which is leading negotiations on behalf of the Government, admitted he wanted 'efficiency gains'. He said: 'Once you get systems set up they are easier to maintain.'

But Dr Tony Snell, an NHS Confederation negotiator on the original GMS contract, said the review would go further and be 'about raising the bar and setting a challenge'.

He said: 'At a stroke one could see many or most of

the standards raised to higher levels. Negotiators are going to want value for money.'

Dr Snell, who set up the PRICCE scheme in Kent which was the prototype for the quality framework, said one option could be to raise thresholds to 100 per cent before GPs scored maximum points.

But he said this may create 'angst' among GPs and would rely heavily on exception reporting.

Professor Martin Roland, director of the National Primary Care Research and Development Centre and an adviser on the construction of the framework, said there would be pressure to 'broaden its scope'. He suggested mental health, musculoskeletal conditions and cancer could be toughened and significant event audit strengthened.

Primary care tsar Dr David Colin-Thome has already signalled the Government wants obesity included, as well as tougher indicators for mental health and cancer.

NICE has also said the Government has agreed to include adherence to its guidelines in the quality framework.

By Ian Cameron

How framework ·New disease areas introduced

·Easy clinical and organisational indicators scrapped

·Higher minimum and maximum thresholds

for scoring points

·More indicators based on outcomes

·Points based on following NICE guidelines

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