The details of incentive schemes to be negotiated between primary care groups and trusts and GP surgeries, announced by prime minister Tony Blair this week, have not been properly worked out, and the high-profile announcement took civil servants unawares, according to HSJ sources.

In a speech to the Royal College of GPs on Monday, Mr Blair announced that an average extra£10,000 per practice will be available for improving services and meeting locally agreed targets.

It is understood that many within the Department of Health were taken completely by surprise by the announcement and were angry that they had been kept in the dark.

HSJ understands that the decision to go ahead with practice incentive schemes followed discussions with GP representatives, who pushed for further devolution of powers to primary care group, trust and practice level.

The decision to announce the schemes on Monday was made very recently, and although some of the details have been worked out, many aspects have yet to be agreed. It is expected - although it is not yet certain - that the money will be ringfenced and recurrent, and that allocation will be locally determined.

Most agreements are likely to include major elements of the various national service frameworks, because they form so much of clinical work, but this will not be compulsory. New clinics and improving access are also areas that could be addressed.

Under the new arrangements,£5,000 will be paid up front to help practices provide improved services, with a further£5,000 paid to the practice at the end of the financial year if it meets locally agreed incentive targets.

This money can be spent in whatever way the GPs wish and could be used to pay themselves a bonus, to reward practice staff or to improve patient services.

NHS Alliance chair Dr Michael Dixon said: 'Essentially what I see happening is that the clinical governance lead for the PCG/T will meet with the practice and set five or six targets.'

National Association of Primary Care chair Dr Peter Smith said: 'The agreements have to be agreed within practices and not centrally. However, I would have expected that national service framework areas would be included.'

NHS Confederation chief executive Stephen Thornton said the schemes would have a major impact on PCTs, with up to 50-60 agreements to be negotiated.

'It gives them a huge management task. They are going to have to design many schemes and this relates to the level of managerial resources they have got, ' he said.

British Medical Association chair Dr John Chisholm said: 'We are devastatingly short of GPs.

'An extra£5-10,000 per practice for modernisation measures will be used up very quickly - for example in paying practice staff.'

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