Serious conflict has arisen between the NHS Confederation and the British Medical Association over a booklet telling GPs how to maximise their gain from primary care groups.

Confederation chief executive Stephen Thornton has written to John Chisholm, chair of the BMA's GP committee, demanding an apology for its 14-page document Maximising Your Influence, produced last month.

He has also written to health minister Alan Milburn to complain about the leaflet, which he told HSJ was 'one of the most sectarian documents I have read for a long time'.

'I want Alan Milburn to publicly condemn these sentiments in the way he has quite rightly condemned others within health authorities for not playing a partnership role,' Mr Thornton said.

He was also angry about PCG guidance saying that health authority members of PCG boards cannot become chairs - even with the approval of the rest of the board.

'This is another example of deals being struck behind our backs between the government and the medical profession,' he said.

'I really think the BMA have got to address the question: are they a serious professional body or an old-fashioned trade union of the worst kind?'

The GP committee booklet sets out the duties and responsibilities of GPs on PCG boards, and also offers advice on how to 'maximise GP influence whilst working within the constraints of the allowances payable and current political realities'.

It suggests that GP board members will need to delegate 'detailed implementation of policy' if 'maximum influence is to be achieved with minimum effort'.

It warns GPs to sift requests for 'a representative from the PCG' since 'this can be a deliberate diversionary tactic of some organisations, including HAs'.

It adds that GPs should insist on receiving executive summaries of long documents.

It also advises that additional payments should be negotiated for project work, clinical governance work and chairing sub-committees, which should be 'superannuable'.

'PCGs are about partnership working. The BMA is using the language of conflict,' Mr Thornton said. 'I hope and believe that what they are saying is being ignored on the ground.'

The language of the document is seen by some as further evidence of a new 'oppositional' tone from the BMA following the departure of former BMA council chair Sir Alexander Macara.

His replacement, Ian Bogle, who was formerly the chair of the BMA's GP committee, built up a reputation for toughness during mostly successful negotiations with the previous Conservative government.

But the BMA is keen to play the issue down. A spokesman said that Mr Thornton was being 'a little over-sensitive'.

'We do feel that he has over-reacted slightly. We are doing what you would expect the BMA to do and that is to represent our members,' he said.

'The nursing profession is encouraging members to play a part in PCG boards, and we are telling our people to make the most of their assets on PCGs.

'But we would be happy to meet Mr Thornton and discuss the issues with him,' he added.