GPs 'get too much performance pay' for meeting targets

GPs get paid for hitting performance targets

GPs are getting too much in performance-related pay, says an expert who helped create the system.

Professor Martin Roland, from Cambridge University, was a key adviser when the GP contract was drawn up in 2004.

He said the proportion GPs earned in performance-related pay - 25% of their income - was distorting care. It should be 10-15%, he said, adding that he was not calling for an overall cut in pay.

Doctors deny the system distorts care but say they would consider changes.

There are three elements to GP salaries - basic pay, a performance-related part and income from extra services provided beyond the normal GP care.

The performance-related portion is paid for meeting certain targets covering things such as diabetes care under the quality and outcomes framework (QOF).

It accounts for 25% of average income, which now stands at over £100,000 a year.

'Rigorous checking'

But Professor Roland, who was one of the two official independent advisers to the government and union negotiators who drew up the contract, said it would be much better if that proportion was reduced to somewhere between 10-15%.

However he added he was not calling for an overall reduction in pay - just a change in the weighting.

"Having it at the level it is encourages an inappropriate focus on things that are incentivised. That is not necessarily in the best interests of patients.

"For example, continuity of care is something that patients say they value highly, but it is not part of QOF."

He also called for more rigorous checking of the performance-related pay system.

Doctors self-report on whether or not they have hit the targets with local health managers working for primary care trusts (PCTs) - which are responsible for carrying out spot checks.

Professor Roland described it as essentially a system based on trust.

He added: "There has been criticism that the approach adopted by PCTs is too light touch. I think that is probably fair."

But Dr Richard Vautrey, of the British Medical Association, said the experience of many doctors was that trusts were "nit-picking" more than ever.

However, on the amount of money linked to QOF, he said: "It would be better to have more money put into the basic sum. Although I would not agree it has encouraged bad behaviour.

"GPs will always do the best for the patient in front of them."

NHS Employers, which acts as the government's negotiators on the GP contract, said it would be inappropriate to comment on the suggestions as officials were currently in talks with doctors' leaders about the GP contract.