Suffolk PCT has been accused by the British Medical Association's GPs committee of bullying over its plans to terminate all existing personal medical services contracts and move the doctors onto new deals under which they would be paid up to£20 less per patient.
With 40 per cent of GPs in England on PMS contracts, the outcome of the negotiations will be watched eagerly by doctors and PCTs.
The 46 out of 59 GPs in Suffolk who are on the PMS contract get£75 per patient. Under the PCT's proposed arrangements, this would drop to either£55 or£68 per patient, depending on the services the GP agreed to provide.
The move follows the reconfiguration of primary care services in the county, which saw four PCTs merged to form Suffolk PCT.
The Suffolk local medical committee, which has been negotiating with the PCT on behalf of the affected practices, has referred the case to the BMA GPs committee. LMC chief executive Bill Robinson said: 'This is a national battle that needs to be fought.'
NHS Alliance chair Dr Michael Dixon said the split was a 'horrifying diversion' that showed a return to 'tribal instincts' of 'PCTs versus GPs, managers versus clinicians'.
'It really worries me, if one side comes out on top, that's going to cause all sorts of ructions and a greater diversion where PCTs and GPs see themselves on different sides and it starts up a lot of problems.'
NHS Confederation PCT network director David Stout said PMS was not a guarantee of income. Reconfigured PCTs would be looking at their local enhanced service payments and PMS arrangements to check they were getting value for money.
'Suffolk may be unusual in scale but I doubt it's unique,' he said.
'PCTs take their commissioning responsibility seriously and it is part of that responsibility to get better value for money across their whole primary care spend.'
Other trusts would be interested if national advice emerged as a result of the case being referred to the GPs committee, he added.
GPs committee chairman Dr Laurence Buckman said: 'GPs have been told their contract is going to be unilaterally changed. They are going to have to work more for less money. We regard this behaviour as bullying.'
He was adamant doctors at the 46 affected practices would not accept the offer made by the PCT, which would leave 500,000 patients without a GP unless the PCT came back to the negotiating table.
'This is going to seriously damage the health of half a million NHS voters,' he said.
Under the new arrangements offered by Suffolk PCT, GP practices can choose to stay on a PMS contact with a new baseline budget calculated on cost per patient. The total existing PMS budget will be redistributed over a five-year period with practices gaining or losing a maximum of 2.5 per cent of their budget per year.
The local enhanced service payments used in Suffolk for procedures such as minor injuries and phlebotomy would be withdrawn, but GPs on PMS would be required to continue providing the services.
As an alternative, the PCT has offered a 'return to general medical services package', which would also be calculated on cost per patient using the present average cost in Suffolk for GMS practices of£55 per patient. There would be an additional£13 per patient if practices signed up to a new range of services similar to those being included in the PMS contract. This is being offered to compensate practices which, if they move back to GMS, will no longer have access to the minimum practice income guarantee created at the time of the new GP contract in 2004.
Suffolk PCT chief executive Carole Taylor-Brown said negotiations had been 'professional' and 'very constructive'. The renegotiations of the contract were not for financial reasons but about fairness of provision across the PCT, she added.
The PCT set up a review of the PMS contact in December 2006. At the end of March, the PCT issued notice that the current contract would come to an end on 30 September 2007. Since negotiations have not reached a conclusion, this has been extended to 31 December.