The bonus scheme that incentivises general practitioners to improve their services to patients is failing in some areas, because of poor oversight of the payments being made. This is the conclusion of the Audit Commission which examined how the Department of Health’s Quality and Outcomes Framework is working.

GP contracts provide that points are awarded for their achievements against different criteria, such as the number of patients given a certain treatment. Those points are then translated into financial rewards. Primary care trusts are responsible for ensuring payments are properly made.

The Commission’s report ‘Paying GPs to Improve Quality’, finds the best PCTs carefully check the administration of claims, arranging annual visits to GP practices by a suitably trained GP to examine evidence and produce good quality reports. These trusts have a clear idea of the impact on patients and whether the payments are being properly and fairly made.

Other trusts are providing poor oversight of probity and value for money. Some cannot be confident that payments made to GP practices are correct and justified, or delivering good value. And some patients may not be getting the services they should be.

One of the main areas of inconsistency across the country is exceptions, whereby GPs can exclude certain patients from their returns for payment. Exceptions can be made for patients who refuse to attend reviews when invited, or where a ‘good practice’ medicine can’t be prescribed for medical reasons. The auditors found that the exception s rule was being widely interpreted in different areas to produce more favourable outcomes.