Managers could bear the brunt of unpopular measures to deal with GP overspends in the reformed NHS, the Office of Health Economics has predicted.

In its report, OHE associate director Jon Sussex argues the government wants to extend cash-limit control to medicines prescribed by GPs just as the abolition of fundholding 'weakens the financial incentive for GPs to comply with this'.

'An overspending GP cannot be sacked overall,' he says. 'It is upon health authority managers that the pressure of ministers and of the central management structure of the NHS can be brought to bear most strongly.'

He adds: 'Pressure on HA managers to try and keep within budget is currently stronger than ever, because the number of HAs and trusts is to be reduced through mergers. Competition for the reduced number of jobs available is likely to be strong. Convicted overspenders need not apply.'

In the longer term, Mr Sussex argues that if some GPs and PCGs are able to 'flout' budget constraints, 'others will be tempted to follow suit'.

If they are allowed to do so, 'the NHS cash limit would cease to be a ceiling on spending and would become instead a floor.'

Mr Sussex argues that to stop this happening, the government will have to create a 'safety valve' for overspending or re-introduce incentives for individual GPs to stick to cash limits.

Controlling NHS expenditure: the impact of Labour's NHS white papers. OHE. 0171-930 9203.£5.