Some GP leaders are warning that PCTs may attempt to cut practices out of the loop by approaching Darzi centres to deliver the jabs.

They also warned that PCTs may approach practice nurses directly, in a bid to get them to deliver vaccines without practices' consent.

A national plan to pay practices to deliver the two-stage vaccination was expected some time ago. But it has been repeatedly delayed, as negotiations between the GPC and the DoH run into problems.

GPC negotiator Dr Beth McCarron-Nash said negotiators were spending ‘every waking hour' working on a deal. ‘Hopefully we're coming to a conclusion soon, but we are fighting to make sure we get it right for practices,' she said.

GPC member Dr Fay Wilson said it would be ‘very prudent for PCTs to be coming up with a Plan B'.

Some LMC leaders have warned that PCTs could use local negotiation to cut contract holders out of any deal.

In a recent email to Thames Valley practices, Dr Paul Roblin, chief executive of Berkshire, Buckinghamshire and Oxfordshire LMCs, warned that PCTs may be tempted to approach practice nurses directly, in an attempt to trick them into offering treatments that were not actually included in the contract.

‘I imagine many of you will have seen this tactic before, and had to put a brake on the magnanimity of your staff,' he wrote.

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• Read the full version of this story in this week's edition of GP dated 11 September.