Some £800m of GP practice income could be linked to commissioning performance.

Senior sources have told HSJ they expect the “quality premium” proposed by the government to reward good commissioning practice or penalise poor performance to account for 10-15 per cent of practice income.

Practices’ earnings from the basic “global sum” and quality and outcomes framework amounted to £5.35bn in 2009-10, according to NHS Information Centre figures. This would put the estimated national value of the quality premium at between £535m and £802m.

National Association of Primary Care chair and Buckinghamshire consortium lead Johnny Marshall said 10-15 per cent was “about the right figure”.

The premium was likely to “bring a bit of rigour” to consortium relationships but needed to be proportionate, he said.

The government has said the premium is likely to be allocated based on consortia’s quality and financial performance, linked to indicators in a “commissioning outcomes framework”.

Dr Marshall said it would have to be implemented in a “balanced” way with care over using indicators.

In 2008-09, the average GP partner earned £237,912. If any adjustment was limited to 15 per cent above or below current earnings, the largest penalty possible on the average partner would be £38,790. If that was all taken out of the partner’s salary, the average pre-tax income of £105,300 would face a 37 per cent cut to £69,613.

Introducing the quality premium will require changes to GP practice contracts. But the British Medical Association has said it would “damage [the] doctor-patient relationship, fundamentally destroying the GP’s prime role as advocate for the individual patient”.

Consortium leaders are likely to be able to decide how to allocate the premium to practices. Some emerging consortium leaders say a significant premium will be needed to incentivise good performance.

Others are concerned about how it will be monitored.

Niti Pall, a West Midlands consortium lead, said: “We are worried [that] consortium managers will have to police our practices. Helping and facilitating is very different from policing.”

UPDATE

Responding to criticism of the premium today by BMA GP Committee chair Laurence Buckman, health minister Paul Burstow appeared to suggest it would be linked to quality rather than finance related performance, such as referrals or prescribing.

He said in a statement: “What we are trying to do with the quality premium is make sure that commissioners are rewarded in the system for delivering the best possible results.

“What GP commissioning consortia will be rewarded for is improving the survival rates, improving the quality of care that is being delivered to their patients.”

Mr Burstow said the government “want them [the BMA] to be fully engaged in making sure these reforms deliver the best results for their patients”.