NHS providers must not turn down patient referrals on the grounds of a primary care trust's location, the Department of Health has warned.

However, last week's DoH guidance outlining the new system of choice at referral says that NHS organisations must also give priority to meeting the conditions of local contracts and commissioning agreements before taking patients referred through the choice scheme from outside their area.

The guidance says that once a provider has accepted a patient it must take responsibility to treat them within the waiting-time standard of 11 weeks. It also warns that the provider may not 'return the patient' to the PCT without the agreement of the PCT.

NHS organisations will only be able to add their services to the national choice menu if they are already commissioned by at least one PCT or approved through the extended choice procurement and providers will normally not be allowed to subcontract work to other providers. The framework adds that further 'rules' to govern removal of services from the national menu and the extended choice network have yet to be agreed.

The DoH also said last week that by July, patients needing orthopaedic and hip replacement treatments would be offered 'free choice' of any hospital provider in the country.

Take control or lose out, GPs told

London's local medical committee is urging GP practices to take control of practice-based commissioning or risk losing out in the growing marketplace for contracts, reports Victoria Vaughan.

In its new briefing on PBC it states: 'Opportunities for practices and PBC groups to become providers of services, not just commissioners, should be actively sought and progressed.

'If general practice does not start taking these initiatives private providers will do so, and our strength in the 'open market' as we now know it will significantly diminish.'

It advises GPs to understand the local arrangements that govern PBC in areas such as budget-setting, contingency funds and freed-up resources.

The LMC report says: 'Despite very clear instructions [from the Department of Health] that PCTs should not top-slice PBC budgets to resolve PCT deficits, PCTs have been calculating PBC budgets according to what funding they have available, including demand management targets of what they need PBC groups to achieve 'in-year'.

Thirty-three practices in the capital have not signed up to PBC. Hounslow tops the charts with nine practices currently not engaged with PBC - meaning they have not produced a plan and received the directed enhanced service payment.