Taking on commissioning budgets may force GPs to give up their historic independence and potentially integrate with secondary care, the NHS medical director has suggested.

Sir Bruce Keogh, speaking at the NHS medical directors summit last week, said the “effect of the icy cold wind of financial accountability descending on GPs from the Treasury” may “force discussions between primary and secondary care”. He said, “If you look in five years time, will GPs be independent businesses [as they are currently]?”

The comments follow concern from the King’s Fund among others that consortium commissioning could further divide primary and secondary care clinicians, and prevent the service integration which many believe would improve care and efficiency.

Speaking to HSJ after the summit, Sir Bruce said he wanted to raise the question of whether, “since GPs will get real accountability, which I’m sure is going to come in a tight financial climate, [will they] become locked into the system in a way [they] might not have been before?”

He said it was possible the change in incentives and accountability would lead to greater integration with secondary services.

Speaking at the same event NHS chief executive Sir David Nicholson said: “I’m in favour of GPs collaborating with the secondary care sector. Having ICOs [integrated care organisations] seems to me the right thing to do. [It is] when it turns into a conspiracy against our patients then we have got a problem.”

Sir Bruce said there was also potential for commissioning consortia to hand responsibility for particular service areas to a lead secondary doctor. Speaking at the summit he said there was a “great opportunity for GP consortia to commission their most appropriate respiratory physician, or rheumatoid physician [for example], to lead on [creating] the best possible delivery of those services”.