The government has confirmed it will begin imposing significant changes to the GP contract at the end of the month.

On Monday it published final proposals following a consultation on plans put forward last year. The proposals, to be implemented from 2013-14, had been opposed by the many GPs and by the British Medical Association.

Plans set out last year included ending payments currently made to practices for “organisational” work such as record keeping, under the GP quality and outcomes framework.

Instead, to earn the same sums, practices will have to meet four new service requirements set out by the NHS Commissioning Board.

This week, in one of several concessions to opponents, the DH indicated this shift would be phased in rather than introduced immediately. The commissioning board will “adapt some elements of the new enhanced services to ensure that they are implemented in a phased way”, it said. The four new requirements relate to dementia diagnosis; telehealth; patient record access; and managed care for those at high risk of hospital admission.

The DH will also make significant changes to the QOF’s clinical requirements of practices, although some concessions have also been made in this area. Two new indicators requiring referral to “cardiac and pulmonary rehabilitation services” will be delayed, as will indicators relating to physical activity and blood pressure control.

The DH will phase out the minimum practice income guarantee – which means those will small patient lists are over-compensated – over seven years, from April 2014. It will also continue work to develop a fairer formula for calculating practices’ core income.

Practices will also receive a 1.3 per cent income uplift next year and there will be an additional £10m investment in immunisations.

The DH’s statement this week said its changes “will stop some GP practices receiving thousands of pounds more than others that care for a similar number of patients with similar patient needs - and distribute resources more equitably between practices”.

The moves follow findings by HSJ last year that some GP practices are paid substantially more than others, regardless of the number and type of patients they serve (news, page 4-5, 1 November).

After excluding specialist GP practices and extreme outliers, practices’ income ranged from about £65-£320 per head of their needs-adjusted population.