The GP who developed the 'inverse care law' - which says those most in need of healthcare are least likely to receive it - has told MPs he objects to giving family doctors financial incentives to do their job.
Giving evidence to the Commons health select committee's health inequalities inquiry, Julian Tudor Hart warned that the quality and outcomes framework could be "dangerous". He said: "I detest payment piece rates. They have predictable effects on reducing everything else and they are dangerous."
Dr Tudor Hart complained that attempts to redistribute NHS resources to the poorest areas had always focused on GP income, rather than investment in patient care.
"If the primary care staff get really involved in their patients' lives I really don't think they need these incentives or disincentives. Everyone else is paid to do their work. [GPs] have enough to live on."
British Medical Association chair Hamish Meldrum said the notion of needing to pay GPs to do their job well was "something we have all struggled with". He added: "You have got to pay GPs and it seems to be not unreasonable to use some of the payment system to encourage and incentivise good practice."
National Primary Care Research and Development Centre director Martin Rowland said poorer practices tended to lose out under the quality framework.
Practices in richer areas with fewer patients with diseases had more incentive to seek patients at risk because they tended to be paid more for each QOF point than practices in poorer areas with higher disease rates. His research showed poorer areas not only had few GPs but also lower referral rates to specialists.