This area shows the problems of trying to move from one commissioning model to another.

Hector Spiteri, chair of the local medical committee, says the area is presently covered by a district-wide commissioning pilot, with 10 commissioning groups.

'GPs selected themselves for these on the basis of like-mindedness,' he says. 'The fixed geographical boundaries of primary care groups are proving difficult because people who got together for the pilot are not taking kindly to the idea of being reconfigured.'

Redbridge and Waltham Forest health authority has consulted various parties and come up with several options.

Waltham Forest is likely to be split into two PCGs. But getting agreement in Redbridge is proving more difficult.

A single PCG would cover about 160,000 people. Creating a boundary along the A12, which bisects the area, would be difficult because 16 practices straddle it.

An east-west split 'would create a situation where most like-minded people would be together', Dr Spiteri says. 'But the boundary would have to be artificially drawn.'

Steve Peacock, the HA's associate director for primary care, is more optimistic, saying the problems affect 'a real minority' of GPs. But he feels the tight timetable has 'exacerbated tensions' and left little time to reassure GPs 'who have never been involved in other ways'.