Dr Chris Grant, a Cambridgeshire GP and former professional executive committee chairman, told the National Association of Primary Care annual conference in Birmingham on Tuesday that PBC was ‘almost impossible' for his practice.

‘We're right on the edges of a big PCT and know that it's only interested in really pushing us into using its secondary care provider services. Our patients want to go to a more convenient secondary care provider,' added Dr Grant.

Gary Belfield, the DoH's acting director general of commissioning, said: ‘Where PCTs are trying to corral PBC, forcing you to work together in an alliance which doesn't work, I think you should rebel.

‘Patient choice is key. I would rebel against your PCT. There needs to be some disruption in the system to get some change coming through. I would rebel against what's happening in your area.'

• Read the full version of this story and a page of news from the conference in next week's edition of GP dated 27 November.
• Editor's blog: Revitalising practice-based commissioning is the only dish on the menu