The British Medical Association is warning that government plans for a shakeup of the GP contact could leave doctors working more for less pay, which could ultimately hit patient care.

The warning comes as the government kicks off a 12-week consolation on its proposals for changes within the contract, a key thread of which is to remove rewards for the organisational facts within the Quality and Outcomes Framework (QOF) to free up cash to fuel improvement elsewhere.

According to the Department of Health, taking away the organisational QOF payments will release £164 million to help fund improvements in patient care, specifically through the implementation of all National Institute for Health and Clinical Excellence recommended changes and the commissioning of extra services from GP practices.

In line with the priorities outlined by health secretary Jeremy Hunt, these extra services will include boosting the assessment of people with dementia, using technology to help monitor the health of patients with long-term conditions and improving online access to services, as well as bettering care management for the elderly and other high-risk patients.

In other changes to the contract, QOF reward thresholds will be increased "so that more patients benefit from the best evidenced care that can help to save lives", and any overall increase in the value of contract payments will give some increase to all GP practices but will be largely directed towards those with less current funding per patient.

The DH said it also intends to free up to £10 million a year to GP practices for two new vaccination programmes for rotavirus and shingles.

GP leaders unsure

But GP leaders remain skeptical of the plans. 

Stressing that practices are already under huge workload pressures, GPC chair Laurence Buckman said there are "real fears that these proposed changes will result in an even greater load at the same time as forcing through a reduction in core funding".

And while conceding that some of the proposals are good, he accused the government of not fully considering the overall impact on practices of installing these changes at the same time.

"This could make it difficult for some practices to maintain the level of care they currently offer, let alone increase their capacity to meet the demands of these proposals," he warned.

According to Jeremy Hunt, however, the proposals "will make sure we support the patients most in need and will help save lives in practices across the country".

The BMA and the Department of Health have been at loggerheads for some time now over the planned changes to the GP contract, and the doctor's union has slammed the government for its "unacceptable" negotiation practices during the process.

The consultation period will close on February 26, and Buckman has called on ministers "to engage in a meaningful discussion" and "listen and act on concerns that are raised".