The quality of NHS care provided by family doctors is patchy and uneven and there is a danger of patients falling through the gaps, a major inquiry has found. Although much care is good, there is an eight-fold variation in referral rates of patients with suspected cancer to specialists and wide disparities in the standard of prescribing, the report by the King's Fund says. As GPs prepare to take control of the majority of the NHS's £100bn budget to buy hospital services, the inquiry says they must work more closely with hospital specialists co-ordinating care for patients with multiple chronic conditions.

That could become more difficult after hospital consultants warned yesterday that whole NHS hospital departments could be forced to close.

Dr Mark Porter, chairman of the British Medical Association's consultant committee, told the annual meeting of hospital consultants that some services, such as cataract surgery, were already being rationed in parts of the country; that the costs of the private finance initiative used to build new hospitals were proving a "toxic legacy"; and the policy of allowing "any willing provider" to compete to provide services under the reforms could mean services transferred to the private sector.

The King's Fund inquiry, chaired by Sir Ian Kennedy, found that among patients referred with suspected cancer, the diagnosis was confirmed in almost one in four patients from some practices, compared with less than one in 100 from others.

The inquiry also found that a third of patients diagnosed in hospital with stomach or oesophageal cancer had been given a non-urgent referral, delaying their treatment. Similar variations were found in stroke care and for patients with long-term onditions, such as arthritis.

Continuity of care is worsening with only a quarter of patients in the lowest performing practices able to see their preferred doctor.

Nick Goodwin, chief author of the report, said: "The level of variation suggests patients get a very different experience – and it is not always a good one."