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However, it is still unclear exactly what the effects of the tougher quality framework for 2006/7 have been.

The loss of 50 access points meant that the maximum that practices could achieve was 1,000. GPs have had to do substantial extra work to prevent the scores from dipping even lower.

Last month GP reported that there were difficulties meeting mental health targets worth 26 points (GP aim lower on quality targets - GP, 9 March).

Although no formal figures have been released, individual practices have been calculating their own quality scores for the end of the financial year. According to national GP leaders, scores have slipped since last year.

Dr Dean Marshall, chairman of the Scottish GPC, said: 'I've only spoken to a few colleagues. Because of a variety of issues scores will almost certainly be lower than last year.'

A similar picture appears to be taking shape in Northern Ireland. GP Dr Brian Patterson, chairman of the Northern Ireland BMA Council, said: 'We haven't got precise figures, and we haven't had the feedback from health boards, but scores seem to be going down.'

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