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Clinical points are likely to be added for tackling alcoholism and the domain for obesity could be expanded, Independent Nurse understands.

Practice funding is set for a wide-ranging overhaul if the DoH is successful in negotiating changes to the GMS contract outlined by Lord Darzi.

Ministers want to scrap the minimum practice income guarantee (MPIG), a top-up mechanism that prevents practices from earning less under the new GMS contract than they did under its predecessor, because it 'mitigates against people exercising choice, and is a barrier to tackling health inequalities'.

However, more than 90 per cent of practices across the UK currently depend on the top-up to maintain their income.

The DoH has also announced that a greater proportion of QOF funding is to be directed to practices in areas of high disease prevalence.

National director of primary care Dr David Colin-Thome said the prevalence formula, which weights the value of QOF points to rates of disease among their patients, and MPIG were 'the two things working against getting money to where it's needed'.

When the new GMS contract was negotiated, he said, 'we damped down the role of prevalence. We want to remove that.'

Practices will not be forced to widen their boundaries, despite the promise of more GP choice. But where patient choice was poor, PCTs would be 'encouraged to find alternative providers', Dr Colin-Thome said.

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