Cambridgeshire GP Dr Chris Grant, a former professional executive committee chairman, said PBC was 'almost impossible' for his practice.

'We are right on the edges of a big PCT and know that it is 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 does not 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 is happening in your area.'

Rebelling against managers to improve services was a key conference theme for GPs.

NHS chief executive David Nicholson's speech was titled: 'On with the practical, armed with the policy - go out there and make trouble'.