Commenting on yesterday's NAO report on the GP contract, NHS Confederation primary care trust network director David Stout said: 'The work of PCTs in world class commissioning recognises the need to make better use of contractual levers to improve the commissioning of general practice and develop a range of skills in this area.'

"We must not assume that the GP contract will provide the full solution to complex problems of service provision and health inequalities, but we know PCTs have started to use the GP contract to drive improvements.

"However, with limited resources, PCTs have focused investments on local priorities to best serve their local populations; this may not always have been in primary care."