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Andrew Lansley’s plans for the NHS cause increasing disquiet among doctors as BMA demands he rethink pro-market changes GPs could more than double their income to £300,000 a year under health secretary Andrew Lansley’s plans for the NHS, according to an analysis for the Guardian – sparking calls from top doctors for the government to reverse controversial policies that would appear to reward physicians who ration care. The revelation comes after the British Medical Association voted to scrap the “dangerous” health bill and demanded that Lansley rethink his radical pro-market changes to the NHS. GPs are central to the government’s programme, and by 2013 will have to band together into consortiums before being handed £80bn of NHS funds to commission care for their patients. At the heart of many doctors’ concerns lies the possibility that, under the reforms, GPs’ pay will be linked to rationing patient care; in essence, being rewarded for saving the taxpayer money. Doctors’ leaders warned that the public would view as “unethical” any move towards a GP’s assessment of a person’s medical need being coloured by a profit motive. At the start of a three-part series on the future of the NHS, the Guardian commissioned Kieran Walshe, professor of health policy and management at Manchester Business School and an adviser to the Commons health select committee, to examine how GPs could profit from the reforms. His work shows GPs could more than double their average pay of £105,000 to £300,000 a year as a direct result of the reforms. At present fewer than 3% of GPs earn more than £200,000 – but Walshe suggests such salaries could become the norm. The pay of family doctors has been a source of dispute since a 2004 deal saw the average annual salary rise from £60,000 to more than £100,000. The prospect of more cash for GPs at a time of austerity and government cuts could prove deeply unpopular with the public. According to Walshe, the most lucrative ventures would see GPs setting up private companies that would turn underspends in their annual budget – in effect, savings on patient spending – into profits. He calculates that individual GPs could net more than £140,000 a year in extra income by saving 5% in commissioning costs. Another £55,000 of income each would come from taking on the responsibility of managing their local population’s needs. A quality premium is also on offer – rewarding financial performance of GP consortiums – as well as the chance for family doctors to create businesses to sell treatments to patients. Dr Clare Gerada, chair of the Royal College of General Practitioners, told the Guardian: “GPs and patients share a unique relationship of trust. If the perception of that trusting relationship is undone then that would have serious consequences for patient care.” One of the key motions passed by the BMA – in its first emergency meeting for 19 years – warned that the relationship between doctors and patients “will be threatened if GP practice remuneration is dependent on rationing decisions [or] the requirement to balance commissioning budgets”. The Department of Health insisted consortiums would not be allowed to make profits by underspending. A spokesperson said the bill would see the NHS regulator Monitor and the new NHS national commissioning board intervene “where there are concerns about the fairness of commissioning decisions. A consortium’s commissioning budget must be used exclusively for patient care. We will not allow a situation where profits can be made at the expense of patient care or patient choice.” But the BMA condemned Lansley’s plans as “too extreme and too rushed … [they] will negatively impact on patient care”. Some 400 representatives of local groups of doctors called on Lansley to “call a halt to the proposed top down reorganisation of the NHS [and] withdraw the health and social care bill”. Labour sought to capitalise on the growing opposition to the bill, which burst open at the Liberal Democrats’ spring conference, when its membership voted to amend the NHS bill so that it promoted “co-operation rather than competition” and asked for half the seats on the boards of GP commissioning consortiums to be reserved for local councillors. Ed Miliband will seek a vote on the NHS reforms in parliamenton Wednesday – hoping to draw out Lib Dem rebels. Lib Dem MPs were meeting to decide how to vote in the Commons debate, but were not expected to vote with Labour.No 10 described the BMA’s general meeting as unrepresentative of its membership. Simon Burns, the NHS minister, said “it has been a day of confusing messages from the … BMA. Fortunately our policy of protecting the NHS’s budget and its values remains clear.” NHS Andrew Lansley Health policy Health Randeep Ramesh Denis Campbell guardian.co.uk