This is a bit long but worth reading – perhaps soon whether you live or die will be down to the size of the doctor’s bonus – from File on 4, BBC Radio 4

Government health reform plans 'unethical' warns BMA

Dr Laurence Buckman says GP bonus payments could undermine trust. A key element of the government's NHS reform programme has been branded “disgracefully unethical" by the British Medical Association (BMA). Dr Laurence Buckman says a system of incentive payments for GPs could be seen as rewarding them for withdrawing treatment. The "Quality Premium" will be paid as part of health service reform plans. Health Minister Paul Burstow said the criticism was "a gross distortion" of government proposals. New GP consortia are due to take over responsibility for commissioning health services in England in April 2013 under reforms proposed in the government's Health and Social Care Bill.

The Premium was designed to encourage doctors to commission improved standards of care for patients rather than cutting services, Dr Buckman told the BBC. But Dr Buckman, chairman of the BMA's General Practitioners Committee, warned that bonus payments could undermine trust between doctors and their patients."We don't understand what the Quality Premium means. We don't understand where it will come from. We rather fear it will come out of our pay and be paid back to us if we do certain things. "It appears that what we might actually be asked to do is to save money and if we save a certain amount of money we will receive some of our pay given back to us. That is something that is appallingly unethical."I don't believe that I should be saying to a patient 'you can't have treatment because that way I'll get paid'."I don't think any patient would sit down with me and have in their head the thought that I would only be being paid by withdrawing treatment from them. I'm not prepared to do that". He said while he accepted doctors should be careful with the expenditure of NHS resources, he thought it was important they remained focused on patients' needs:"What I'm not prepared to do is receive pay … on the basis that I withdraw treatment from a patient. That is disgracefully unethical and most GPs will have nothing to do with that," he said.

The idea behind the Quality Premium is contained in an "Impact Assessment “document published in January by the Department of Health alongside the new Health Bill. This says payment of the Premium "should be linked to the outcomes that are achieved collaboratively through commissioning consortia and the effectiveness with which they manage financial resources".
In an interview with the BBC, Mr Burstow dismissed the suggestion that the payments were designed to incentivise cost-cutting by family doctors."That really is a caricature, a gross distortion of what we are trying to do here," he said."What GP commissioning consortia will be rewarded for is improving survival rates, improving quality of care given to their patients.”If the BMA haven't understood that at this stage then we clearly need to talk to them further."
Mr Burstow confirmed that the Quality Premium payments would be paid to successful GP consortia by the new NHS Commissioning Board. Funding would come from within existing NHS budgets, he said. The BMA has already warned that the Health and Social Care Bill could threaten the confidentiality of patient records. In a letter to government the organisation claimed that the Bill gave broad powers to a number of bodies, including the Health Secretary and the NHS Commissioning Board, to obtain confidential information. A Department of Health spokesman insisted the Health Bill did not undermine patient confidentiality and left legal safeguards intact.

File on 4 is on BBC Radio 4 on Tuesday 1 March at 2000 GMT and Sunday 6 March at 1700GMT. Listen again via the BBC iPlayer or download the podcast.