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Plans for quality premium ‘will increase inequalities’

GP leaders have warned that the plans to award commissioners with a quality premium do little to allay fears that the initiative will increase health inequalities.

The NHS Commissioning Board planning guidance - published today - says that CCGs will receive extra funds based on their improvements on outcomes including reducing avoidable emergency hospital admissions, reducing death rates, the ‘friends and family’ test and reducing healthcare-associated infections.

The document said: ‘The quality premium will also include three locally identified measures. Each CCG should agree these measures with the NHS Commissioning Board after consideration with Health and Wellbeing Boards and key stakeholders, especially patients and local community representatives.’

However, Dr Richard Vautrey, a GPC negotiator and a GP in Leeds, said the plans are likely to penalise CCGs working in more deprived areas.

He said: ‘We continue to have concerns that potential for widening health inequalities.

‘It will be easier for CCGs in areas without deprivation to achieve indicators compared with those with higher levels. Yet it is usually the areas of higher deprivation that need them as a resource.’

Dr Vautrey warned that patients could perceive a potential conflict of interest if they ‘believe that GPs are being given money at a time when the health service is facing cuts.’

He added: ‘If CCGs are setting targets for practices that are linked to commissioning outcomes, it is appropriate for them to use the resources according to the activities practices will have to do to deliver on those targets.’

Dr Beth McCarron-Nash, a former GPC negotiator and a GP in Cornwall, said: ‘I’m concerned that what we mustn’t do is interfere in the vital relationship GPs have with their patients. Any decision we make must be on their clinical need not because of a financial incentive.

‘That is not to say we should not be cost-effective and use NHS services appropriately.’

However, she added, reducing costs does not equate to quality.

But Dr Mike Dixon, chair of the NHS Alliance, said that as long as personal financial incentive is removed, it is right that GPs have more influence over the way resources are allocated.

He said: ‘I think this creates the right sort of balance. Previously, we had effectively no real incentive to look at cost and value at all.

‘The bit missing out is how much the incentive is going to be. It’s rumoured that it will be £5 per patient, which is a fair whack.’

A spokesperson from the NHS Commissioning Board said regulations on whether CCGs can pass proceeds from the premium to individual practices will be made next year.

‘This will be subject to the regulations due to be made early next year, but we anticipate that CCGs will have flexibility to decide how they spend the payment, provided that it is used in ways that improve patient care and / or health outcomes.’