Primary care trusts have criticised the Department of Health for backing away from plans to allow them to set local incentives in the national GPs’ bonus schemes.

The proposal was originally made by health minister Lord Darzi in his next stage review.

It was one of a series of changes to the quality and outcomes framework that the department put out for consultation.

However, it was heavily criticised by doctors’ groups, including the British Medical Association and the Royal College of GPs.

PCT Network director David Stout criticised the DH for not giving “any sense of timescale or firm commitment” to introducing the local element when it announced last week the changes it would implement.

The decision was one of several examples where the department’s policy was failing to support commissioning, he said.

A DH spokesman said the department “remained committed” to giving the local NHS a say in investment and suggested PCTs should set up “local quality schemes”. However, these would be outside the framework.

Balancing investments

The spokesman said: “Over time, we will need to review the balance between national and local investment for quality of care to ensure that PCTs are able to address the particular health needs of their local populations, whether this is through the quality and outcomes framework or local enhanced services.”

Mr Stout said: “There are a number of things [and] this would be one, where the way the department operates isn’t really designed to support commissioning.”

He said some policies were “designed to keep control at a national level” or, like the dementia strategy unveiled last month, were focused on provision.

He said: “There’s a need for a much stronger alignment of policy with commissioning and this is one example of that.”

The DH said the National Institute for Health and Clinical Excellence would be taking on the responsibility for reviewing clinical indicators but said that the final choice of indicators would still be negotiated by the BMA and NHS Employers.

Mr Stout said the network welcomed the news that NICE would have a greater role in overseeing the development and review of framework indicators.

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