NHS Clinical Commissioners, which represents a large number of clinical commissioning groups, has said GP “workloads are at breaking points and GPs are ready to buckle under the strain”, which will affect willingness to take part in commissioning.

NHSCC’s comments come after health secretary Jeremy Hunt reiterated his concerns about the role of out of hours primary care in the A&E problems.

Steve Kell, co-chair of NHS Clinical Commissioners’ leadership group and chair of Bassetlaw CCG, said in a statement: “We are hearing growing concerns from our members that at practices across the country workloads are at breaking points and GPs are ready to buckle under the strain.

“There is little doubt that a fire-storm has being whipped up over what is happening in Accident & Emergency Departments, with primary care provision, the GP contract and out of hours care being dragged into the mix.

“NHS Clinical Commissioners role is to speak for local commissioners, but as membership organisations we recognise that the morale of GPs is fundamental to how CCGs can operate. After all, if GPs are feeling squashed by their workload they are going to be far less able and willing to then engage on top of that with the commissioning agenda. CCGs need the foundations of strong general practice upon which to build.”

Dr Kell said: ““CCGs are best placed to lead on developing local solutions for local circumstances.  However we do believe the solutions for the current problems have to be ones for the system as a whole. We call on partners representing commissioners and provider including NHS England, the Foundation Trust Network and the NHS Trust Development Agency to work with us to identify solutions at scale which can then be adapted and implemented by clinical commissioning groups and area team in their role as direct and specialist commissioners.”

Mr Hunt, speaking on BBC One’s Andrew Marr Show on Monday, insisted he was not blaming GPs for the problem but said they must be made responsible for the out-of-hours service provided to patients on their list.

The health secretary claimed the service “deteriorated” when the GP contract was changed in 2004, with the public losing confidence and turning to A&E departments.

Mr Hunt said: “I would never blame GPs because I think they work extremely hard. I’ve been in GP surgeries and they have very, very long days.

“But I do think that contract is one of the contributing causes, yes, because I think what happened was when you removed the responsibility for services at the evenings and weekends from GPs, the service deteriorated and there’s a great loss of public confidence.

“If you need to speak to a GP out of hours, you’ll generally be speaking to someone who’s a long way away from you who doesn’t know you, can’t see your medical notes.”

While he was not calling for family doctors to personally be on call all night, he added: “I think we need to go back to GPs having responsibility for making sure that for the people on their list, there is a good service available.

“And I think the reforms we’ve had in the health service help to make that happen, but I think there’s lots more we need to do.”

Mr Hunt said having “better alternatives in primary care, a closer personal relationship between people and their GPs - something that many people think was lost by those contract changes - that’s going to be at the heart of the solution”.