Ministers seek talks with GP bodies over quality premium

The admission came during a debate on the Health Bill in the House of Lords last week as renewed concerns over conflicts of interest were raised.

Earl Howe declined to give an indicative figure for the payments, but said CCGs should not be restricted in how they used the cash, meaning payments could be made to GP practices and not necessarily used on services.

The quality premium will be paid by the NHS Commissioning Board as a reward to CCGs whose decisions had improved service quality or health outcomes in their area.

Earl Howe said the payments would not be a reward for financial efficiency. However, “final decisions on the design of the quality reward have not been made yet… we intend to discuss our proposals further with the profession. This is not about paying GPs extra. It is about rewarding CCGs for successful commissioning.”

He also said: “Great care would be needed to devise any such payments so that they are fair and proportionate, and create the right incentives to deliver high-quality care for patients… there is quite a lot of thinking still to do about the design of this payment. I am sure we will return to the subject at a later date.”

Earl Howe argued that only allowing the payments to be spent for the benefit of patients risked “blunting the scheme”.

“We must not exclude the potential for the CCG to allow members to spend this money as they see fit, including rewarding the members for their work if that incentivises the membership,” he said. “If the payment is required to go into the commissioning budget, it might well eventually be no incentive at all.”

Labour Lord Philip Hunt, who is also chair of Heart of England NHS Foundation Trust, said Earl Howe’s remarks were “broadly reassuring”.

But, he argued, patients might question the motivation of GPs who gained personally from decommissioning local hospital services. “I am genuinely concerned about this impacting adversely on the doctor-patient relationship.”

An amendment proposing the measure be removed from the bill altogether was withdrawn. Other changes which could require the payments to be spent improving health outcomes were not moved, meaning they remain open to negotiation.