Sir David Nicholson has said the NHS’s interpretation of February’s Francis report, combined with unseasonably bad weather, may have caused the collapse in accident and emergency performance earlier this year.

The NHS England chief executive said “two things happened” which could explain the problems experienced by A&E units in March, when performance was markedly worse than past years.

He said: “One was the weather. March was much more like a January.

“And secondly you had the publication of the Francis report. It is difficult to work out what the impact [was]. Undoubtedly though, parts of the system received the message that access to services was perhaps not as important as it used to be.”

Also in the interview, Sir David criticised the “demonisation” of GPs, but highlighted evidence that poor general practice could cause greater use of A&E.

The NHS England chief executive said “general practice” was “a cornerstone of the NHS” and internationally admired.

He said: “I am a big fan of general practice and I think the way sometimes it is demonised is very bad, and very bad for patients.”

However he said primary care needed to be “modernised” and that the NHS needed to “think very carefully” about delivery of “what’s traditionally described as out of hours care” and responsibility for patients after discharge from hospital.

The health secretary has indicated he thinks GPs’ contracts should be changed to give them more direct responsibility for out of hours care.

Sir David said: “Whether you have to [change services] through the [GP] contract or another [method], I’m very open to thoughts around that.”

He said the first stage of NHS England’s ongoing review of urgent and emergency care − to be published this month − would demonstrate the potential impact of poor general practice: “It shows really very clearly that in those practices where patients are the most satisfied [you] have the lowest utilisation of A&E. You can’t say it’s a causal link but it is very marked.”