Dr Clare Gerada fears that clinical commissioning groups (CCGs) may use ‘risk stratification tools’ similar to those used by US health management organisations to identify potentially expensive patients.

These patients could then find their care ‘outsourced to third parties such as disease management companies’, Dr Gerada wrote in this month’s BJGP.

Dr Gerada said CCGs could cherry-pick fit, healthy and younger patients because they are cheaper and would deliver more profits.

She said: 'Patients with complex co-morbidities may find their care being managed by a multiplicity of disease management systems, all designed, not to improve care, but to increase the management firm's profits.

'Care for patients will be fragmented and continuity compromised due to perverse funding arrangements.'

Dr Gerada argued that GPs should be involved in planning care, but that ‘ it does not make sense for GPs to spend their time negotiating contracts with other doctors, managers, and hospitals, and even less to bear financial risk for their expensively ill patients’.

‘It turns GPs into rationers of care and away from their professional role as patient advocates,’ she warned.

Dr Gerada also predicted that mergers between CCGs would be 'inevitable' as high-cost patients could force smaller groups into bankruptcy.

She added that CCGs could also introduce personal health budgets that would see vouchers given to patients for ‘year-of-life-care’.

But she warned that evidence from the US shows co-payments increase bureaucracy, do not save money and could ‘disproportionately increase death rates among the poor and chronically ill’. 

She said: ‘Rather than trying to implement the US’s failed market-based model... the UK government should improve and protect the NHS and its achievements.’