GPs may demand more money before they agree to participate in the Government's health reforms, ministers have been warned.
Under plans to alter the way the NHS is run, family doctors, many of whom are already earning over £100,000 a year, will be required to form "consortiums" to commission care for their patients.
But ministers have yet to reach agreement with the doctors' union, the British Medical Association, on making the necessary changes to GPs' contracts to allow the reforms to go ahead. NHS employers have warned this could cost the Government millions of pounds more in unbudgeted costs.
The last time the government renegotiated the GP contract in 2004, it cost £1.76 billion more than was predicted in its first three years while GP productivity fell. "The last time the government negotiated with the GPs it was quite a horrendous exercise," said David Stout, deputy chief executive of the NHS Confederation.
"What you have to remember is the GPs are very good at negotiation and the Government's problem is this: the legislation says that all GPs have to be in these new GP consortiums – but it is not in their contracts. Either the Government chooses to impose this on them or they have to renegotiate and that could be very tricky."
The Public Accounts Committee has released a report warning that ministers have "no control" over many of the costs of the NHS reforms.
Under the Department of Health's initial estimates the cost of the reforms will be around £1.4bn, offset by a 33 per cent (£1.7bn) reduction in administrative spending by 2014-15. But the Committee warned these savings were far from certain and said it was not clear what contingency plans the Department had in place.
Richard Vautrey, deputy chair of the BMA GPs' committee, denied doctors would take advantage of the contract renegotiation to get more money: "We don't see this as a financial issue because most GPs will not be directly involved in commissioning."
He added the BMA was unhappy at plans put forward as part of the bill for GPs to be given financial incentives to commission care "efficiently". "We think this would undermine the doctor/patient relationship," he said.