Allowing GPs in a single clinical commissioning group to break away from the nationally agreed quality and outcomes framework could lead to the “Balkanisation of national healthcare”, the British Medical Association has warned.

Yesterday HSJ revealed that NHS England had approved a local alternative to the framework for practices in Somerset.

Details of the Somerset Practice Quality Scheme agreement - seen by HSJ - state practices which choose to take part will only have to report against five of the 67 indicators in the 2014-15 framework.

Instead practices will have to report to Somerset CCG quarterly on their progress against developing integrated care for people with long term conditions, reducing avoidable hospital admissions and improving the sustainability of general practice.

Richard Vautrey, deputy chair of the BMA’s GP committee, told HSJ that practices around the country were already working on these issues, on top of QOF.

He said: “It sends a signal that NHS England is no longer bothered with structured long term condition management and that the Balkanisation of national healthcare is on the cards.

“How NHS England can really measure any of this is beyond me. I can’t believe they’ve really read what they’ve signed up to, unless of course they just wanted to send a signal that an area that wanted a local deal could have one.”

The QOF indicators are designed to incentivise best practice in the care of people with long term conditions; compliance generates significant extra income for practices.

In a statement on the plans released this morning, NHS England said it would not be offering local alternatives to QOF in any other parts of the country during 2014-15.

It said the work in Somerset was a one year trial that would be independently evaluated by the South West Academic Health Science Network upon completion.   

Linda Prosser, director of commissioning for the Bristol, North Somerset, Somerset and South Gloucestershire Area Team, said: “NHS England is pleased to be supporting this locally designed, innovative approach. 

“It’s responding to patient needs by giving GPs greater flexibility and potential to work closer together to improve primary care services for people locally.”

Matthew Dolman, chair of Somerset CCG, said the majority of practices would be taking part in the pilot.

“The one year pilot will be subject to rigorous evaluation and we hope the results will be of interest, not just locally but nationally as well.”