Nationally negotiated pay means commissioners' hands are tied from using bigger salaries to attract more good doctors, the Commons health select committee was told last week.

York University's centre for health economics director Peter Smith supported more local incentives and a locally agreed GP contract.

Professor Smith said: "There are issues around a centrally agreed contract which doesn't allow variation. If you believe in decentralisation, PCTs ought to have the power and capacity to attract manpower."

Local influences

He said they had the resources but could not pay doctors extra. "I think there is a strong case for [locally negotiated contracts]. In the absence of that, PCTs have to have other incentives they can use."

The committee, which expects to publish a report on health inequalities early in the new year, was also told the economic downturn could cause a disproportionate drop in spending on public health.

Mark Sculpher, also a professor of health economics at York, said: "There will be some very difficult decisions about public health interventions. In particular it is very much easier to say yes to cancer drugs than public health interventions."

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