Government swine flu vaccination negotiations with the British Medical Association “did not reflect well” on either side, an independent review has found.

The review, led by former Welsh chief medical officer Dame Deirdre Hine and published last week, said the response to swine flu overall was “proportionate and effective”, but made several recommendations for future preparation.

One was that the government should agree a “sleeping contract” with the BMA’s GPs committee for GPs’ role in a vaccination programme.

In September last year, the Department of Health agreed to pay GPs £5.25 per dose for the first phase of the programme, and if necessary to lower the threshold for achieving scores under the quality and outcomes framework.

Negotiations for the second stage of the programme - to vaccinate different risk groups - broke down in December and primary care trusts were told to reach local agreements, potentially not using GPs at all.

The review said the negotiations “did not reflect well on either the GPC or DH”.

Dame Deirdre said in her report: “I have also heard that capacity exists within the GP system to support an emergency response, and that in 2008 it was agreed, in principle, that GPs would dedicate capacity to any pandemic response provided that overall practice income was protected and costs reimbursed.”

A sleeping contract would make the process smoother, she said. Instead, the negotiations had taken place in tandem with the start of the pandemic.

The review found the total cost of preparation and response was £1.2bn, most of which was spent on antivirals, vaccine and antibiotics.

It said there should have been break clauses in all government vaccine contracts so, when no more was needed, it could stop paying. But the report said GlaxoSmithKline, one of two suppliers, had “not been willing” to include a clause.

Dame Deirdre said that in some areas critical care beds were in short supply during the pandemic. If the flu had been worse there would have been a significant shortfall.

She recommended the health service carries out further work on “surge capacity”, particularly in paediatric critical care.