Moves to tackle health inequalities must start with the most excluded, the NHS Confederation has urged.

Its report In Sickness and In Health, published last week, says many health inequality measures are getting progressively worse.

It calls on the government to abolish the£600m-a-year payments made to GPs through the minimum practice income guarantee, saying it prevents 'equitable distribution' of resources as it is based on historic levels of funding rather than real patient need.

The confederation also says that the quality and outcomes framework - the method of reward for GP performance - needs to be changed because it does not offer incentives to practices with patients who have high levels of disease.

At present, the QOF pays practices with high disease levels at a lower rate per patient than practices with low disease prevalence. It says the existing payment system has disadvantaged certain practices, particularly those in deprived areas.

The report also calls for a fresh push to reach the millions of people who are not accessing the healthcare services they need and improvement in access to services for people at the earliest stages of disease.

NHS Confederation chief executive Dr Gill Morgan said: 'Growing health inequalities are the scourge of a civilised society.

'Our expectations for infant mortality rates and life expectancy define the kind of society we are trying to create and we must take action now to stop the gap between rich and poor widening further'.

She called on the NHS to ensure that good practice on health inequalities was spread throughout the country.

'Our members are taking bold steps to find and treat the people who have been excluded for so long. We must use the increasingly sophisticated social marketing technology to seek out people who are at risk,' she added.

To download In Sickness and In Health, click here